Revision TKR _My Saga of a Hopeful Happy Ending - Nerve Burning??

[LaPaz]

Nancy, I have been so worried about you---it sounds like it was harder than we thought. How are you doing now in the second week? That was when I began to feel like I could take care of myself fairly easily. How long will you stay in California.

I pray that this is the final surgery to get your life back. I have worried so about my left quad---it is still not 100% and is smaller than the right quad. I have begun to do serious weight lifting with that leg. I worry that I am too old to fully rehab it and then I think---baloney, I can do it.

I am sure that you will come back too---it will be hard, but not impossible.

Hi Kelly, I am 2 weeks from my surgery and just had the staples removed. The wound looks good and I do not have a lot of swelling. My range of motion has been going in reverse and I am now down to about 55 degrees. The stiffness and pain is very intense and makes it hard to do a lot of PT. I went yesterday for my first office PT and they feel I can reverse the numbers quickly so I really hope so. My extension is 0 so no problem. I am still having to use a walker as the knee just does not have the strength to hold me for long and sometimes just buckles without warning. I am not comfortable sitting as my ROM is not enough and I can not position myself to be comfortable for longer than a few minutes. I am more active and have tried to be up and about during the day not in bed much. My leg aches most of the time from my toes, foot ankles, Tibia to my femur. My ankle feels like I hit it against something. I can lift my heal and do short heal slides just above the ankle. I have been trying to let the leg dangle over the bed or with pillows propped up. Nights are difficult so my mornings are not easy to get going.

My OS noted I had a bow in my femur that he said I was born with. I could see it on the xray real clear but don't remember seeing it before. I think I have been worrying about it with weird thoughts going in my head that my femur is bending from all the stress. I know that is not so or possible but just something in my head. Maybe because of the drugs. Oh, how I hate this drugged feeling. No, this surgery is much different then all I had before even the bi laterals were not this bad. Kelly, hope you don't have to ever have a stem or hinged knee. I am sure Sonja can agree to that! My OS said the stem is 113 cm long and goes half way up my femur.

Kelly, Did your quad bother you this ski season? What muscle group is the VMO?

 

[skigirl]

Nancy, I am sorry to hear that you are struggling---I think you are going to have to surrender to your knee and lie in bed with your knee propped up on three pillows until the swelling goes down. Even if you don't have a lot of external swelling, there must be swelling in that knee which is blocking your rom. Too much activity is counter productive at this early stage. Pain and swelling control: elevation is the key

I think you are going to have to get some good books or something and just crash for a week or so. It is not forever, but you need to keep that knee up at all times unless you are on the way to the bathroom or to pt. Nancy---do you have access to a library? Or a Kindle? or books on your iMac?

I also hate the drugged feeling--but did not try to fight it for the first two weeks. Are you taking your meds by the clock? Remember that Jo always says that pain contributes to swelling. For now, just surrender yourself and take the pain meds by the clock and keep the leg up----I think that if you do, a week at most will make a big difference for you. I hate the way you get all sweaty when you do anything at all. Don't forget that ice is part of the pain relief.

Nancy, I know some of the feelings you are probably having---I thought a tkr would be the end of knee problems and I resented the fact that I had to have an additional surgery and rehab YET AGAIN! I was tired---my poor body does not need any more major surgeries in the next years, I hope. With the first tkr, I was so hopeful and wanted to rehab as much as possible. With the second, I knew that I had to rest the first two or three weeks and then rehab again. With the third surgery, for the Adhesions, I had to wait almost 8 weeks to rehab the knee and by then, I had lost interest!!

The VMO is part of the four quad (hence quads) muscles on your thigh. It helps to extend the knee and to keep the kneecap in the right place. Since mine is still weak, the kneecap is pulled more to the outside by my IT Band. So, I have to constantly stretch the IT band (ouch, ouch) and work on keeping the knee cap loose. I am devoting the next month to trying to get the VMO back in working order!!

It has been almost a year and I am almost there. If you need something, PM me and I can send it to you books? DVDs? (I have Jane Austen!!) knitting yarn---whatever it takes to make you happy in mostly bed for a week or so. Kelly

 

[1ELISEA]

Hi Nancy/LaPaz
Well, at least you have the surgery behind you.

OMG (oh my goodness) Nancy, you are only a couple weeks out of surgery, please take it easy!!

I didn't start PT until 3 weeks in, and then had to go back on crutches and non weight bearing. Thought I'd never get a decent ROM and was sliding backwards. My PT was fantastic and with massage and stretching at every visit, I gained about 5 degrees a week. It took awhile, but I got there.

As for dangling your feet, you are much better than I. Could not stand to dangle my feet or sit in a chair with legs on the floor for many many weeks. I would try, and last for all of ...... maybe 5 minutes tops, and then I needed to have them up and elevated.

And I too, used a walker. Think of it as being able to practice walking without a limp. And you will know when you no longer need it. I would go into the kitchen for ice, and leave the walker, and then the crutch, up against a counter and start to walk out of the kitchen before remembering that my walker was in back of me.

Wishing you the best; in addition to an uneventful healing!

 

[skigirl]

Nancy, Elisea is right---you are so early in your recovery and you knew going in that this one would be a challenge. You will get there, just try to let this early stage flow by you so that the good stuff will come along too.

 

[RestAssured]

Kelly, hope you don't have to ever have a stem or hinged knee. I am sure Sonja can agree to that! My OS said the stem is 113 cm long and goes half way up my femur. What muscle group is the VMO?

Nancy,

Not for a moment do I regret the HK Smith and Nephew. The hinged knee has saved me from falling countless times! My problem is the VMO and the kneecap. Some days it behaves, some days it has a mind of its own!

 

[LaPaz]

I agree with all of you and it is tuff to just lay around but that is basically what I have been doing. I sleep a lot from the drugs and reading, watching TV or doing computer I can only do short amounts of times. I wake up like clock work for my drugs. Have not had to set an alarm but I have had to write down the times I take it so I don't OD. Right now about every 3 hours sometimes I go 4 hours. When I have pain before the 3 hours I use ice or my electric stimulation. Today in PT they put on the Electric muscle stimulation to wake up my quads. Wow, that really was tuff to handle but the rest of the day my Quad felt not so tight. They also did a nice massage that loosened a large knot I had where the drain tube was. Glad I decided to spend time in the States for PT rather than return to Mexico.

Kelly thanks for your generous offer but for now I have mostly been watching cable movie channels which is new to me as I have no cable in Mexico. I just keep falling asleep so miss most of the movie. When I say get up I mean out of bed and into the den on the couch. At least I can socialize more. But for being on my feet not much at all just bathroom and a few times just to get up and stretch out.

 

[skigirl]

Nancy, that sounds about right for where you are now---by the end of next week, I am sure you will start to emerge from the drug haze. I don't get drug addicts---ugh what an awful way to spend your life.

I am also glad that you are spending time in the US before heading back to Mexico---you can see how the pts work here and that will help with getting help in Mexico. Are there massage therapists there? /they must be cheaper than here---maybe you can find someone to keep that quad loose for a while. I had a massage therapist work on me for the first two months and it did help with keeping my quad functional and soft.

I hope it is working out being at your mom's house. It might be nice for her to be able to help you a little too.

 

[LaPaz]

I am 4 weeks out from the surgery and making very little progress so I have not wrote for a while. My flexion is 73 degrees which should be better according to my OS. I just started to walk without the walker and find myself a little unsteady and real slow. Stepping up or down is very difficult and at those times I really need support. I still find sitting not comfortable for more that about 10 min. I can take only short walks as I still tire very easy and the knee begins to hurt. I am using a Jacuzzi to do some stretching and bicycle kicking which seems to loosen my knee but the progress is slow and the knee just does not want to give much. My OS wants me to be more aggressive at PT to get the knee bending but it is pretty painful. The PT tries to be gentle about it and quits when I say I had enough. I knew this was not going to be an easy recovery but did not expect it to be this difficult. I am really sick of dealing with recovery, pain, meds, my stomach and not doing anything. Yes, there is a little depression but I keep telling myself I will get better. Wish I had more positive news to report.

 

[Pumpkin]

Nancy,
Like many of us here you are on the slow road to recovery. You are only 4 weeks out and you knee has been traumatized, it is going to take longer.
I am still making small gains at 19 months with a recent increase in ROM, strength, decreased pain, and increased activity. You have plenty of time.
Sounds like your knee is telling you to rest, ice, elevate, and medicate for a while longer. I still do this when my knee speaks to me. Get the swelling, and inflammation down first, all the others will follow. See skigirls post above #62, there is a link to information about inflammation and swelling.
Take good care,

 

[skigirl]

Nancy, I so totally relate to being sick of rehab and knees. After that third surgery to remove the adhesions---I found that I was depressed. I thought having a tkr would end knee surgery forever and i was disgusted and angry that I had to have that surgery. Also, the 8 weeks with very little activity did not help.

I finally looked at myself and frankly, I was even sick of my complaining!!! So, I found things that I could do and then did them. I read about 40 books. I knitted a scarf. I watched the first two series of Downton Abbey--loved it!! I would give myself a starting and ending point for a walk, then try to increase it each day.

I began to work in my studio--one hour of work, two hours resting. This is a time when you will have to reach inside yourself for the strength and happiness that you know is there. I was so tired of people saying to me, You are so strong!! I did not want to be strong, I wanted to be magically healed and be my old self.

I know how tired and depressing this is---but, there is light at the end of the tunnel. I am a year out and I have been going on long bike rides. I skied 80 days this winter, I am better---and you will be too, but you just have to live through the next few months. Don't worry about rom at this early stage---just do what you can, stretch often and do heel slides lots and lots.

First are the mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!

Myth busting: no pain, no gain
Swollen and stiff knee: what causes it?
Progression of activity for TKRs
How Long Does Healing Take ......
Chart representation of TKR recovery
Energy drain for TKRs
Elevating your leg to control swelling and pain
Using ice -

 

[Janet2012]

Hi Nancy, just popping in here. You mention using the jacuzzi. Do you mean a hot water tub? At only four weeks, the hot water could be increasing the swelling, which would inhibit your ROM. You might try letting that go and sticking with icing for now. Even now, at 11 months, while a soak in the tub feels good, I feel the swelling more afterwards. A swimming pool, on the other hand, while you will feel the water pressure, it is cooling, takes weight off the knee, and makes stretching and flexing easier. You may be able to get pool therapy through PT. I just got back from a hiking trip in Utah, and I largely attribute the pool for building up my leg muscles enough to do that kind of climbing and walking!

 

[maryo52]

Nancy, I think on Bonesmart we are not just a family of bionic joints, we are a family of doers who do not take well to not doing our usual activities. We are reluctant couch dwellers. We get discouraged. We hate not having control over what's happening to us.

I see you have progressed from 55 on April 18 to 73 today May 1. Let me use my math degree here: 18 degrees in 13 days is about 1.5 degree a day. Eighteen degrees may seem paltry, but extend that forward: a degree a day for 20 days will hopefully get you past 90. So listen to Kelly and don't be tempted to push your knee harder. Both Kelly and I stand by the belief that pushing a knee that's has or has had scar tissue will provoke scar formation.

I was in your shoes two years ago. I was discouraged beyond recognition. I cannot stand to see photos of myself from that period. It was the hardest time of my life. It's easy for us to advise you to surrender to the immensity of your recovery because we're out of it now. I know I struggled terribly with acceptance at the time. All I can say is that many of us understand and sympathize.

 

[1ELISEA]

I am 4 weeks out from the surgery and making very little progress so I have not wrote for a while

As the other have said, YOU ARE MAKING PROGRESS!

Keep on keeping on and you'll get there. Annnnnnnnndd go ahead and write even it you think you aren't making progress. We'll be here to encourage you on.

And 4 weeks is the hard part; not hurting so much as before, but everything seems... kinda .... not settled. And of course, our own expectations are to be walking miles without pain... yeah, not the case for most of us at 4 weeks.

Hey, I got put back on crutches about that time, with no weight bearing so I know of what I speak!

Which leads me to my next comment:

The PT tries to be gentle about it and quits when I say I had enough.

So instead of giving up, have the PT massage and stretch it. When I was back on crutches, and non weight bearing, thinking I'd never neeeverrrrrr get ROM, my PT gained me about 5 degrees a week by stretching and massaging.

I would hang my knee and leg over the side of the table and she would protect the leg in her lap as she sat lower and in front of me. She would gently move it back and forth in the tiniest of increments (stretching) while also massaging the muscles. Never hurt it once. Ask your PT about this method; they should know how to do it, I would imagine.

 

[LaPaz]

Myth busting: no pain, no gain
Swollen and stiff knee: what causes it?
Progression of activity for TKRs
How Long Does Healing Take ......
Chart representation of TKR recovery
Energy drain for TKRs
Elevating your leg to control swelling and pain
Using ice -

Thanks for all these helpful links Kelly. I do have many things going on so I am very busy in some ways just trying to get a lot of projects done at my mother's house. Projects that needed for me to be here to see them through. I just wish I could be even more involved but people tend to understand as I lie around and dictate what needs to be done. hahaha

 

[LaPaz]

Hi Nancy, just popping in here. You mention using the jacuzzi. Do you mean a hot water tub? At only four weeks, the hot water could be increasing the swelling, which would inhibit your ROM. You might try letting that go and sticking with icing for now. Even now, at 11 months, while a soak in the tub feels good, I feel the swelling more afterwards. A swimming pool, on the other hand, while you will feel the water pressure, it is cooling, takes weight off the knee, and makes stretching and flexing easier. You may be able to get pool therapy through PT. I just got back from a hiking trip in Utah, and I largely attribute the pool for building up my leg muscles enough to do that kind of climbing and walking!

The great thing is I can control the temp of the water so I don't make it too hot just enough that the muscle will relax and allow me to work it. We have a pool also but it is 78 degrees which is too cold for me. I have the water about 86 degrees which feels real comfortable.

 

[skigirl]

so---you can think of all the things that you have gotten done this summer and bask in your success.

 

[LaPaz]

Today at PT I was able to bend 82 degrees what ever they are doing along with what I am doing must be working if only I can keep making this progress. They do a lot of massage and stretching not while hanging my leg over the side as they have not done that yet. They always end by icing and electric Stimuli so when I leave I am not hurting. I usually ice and elevate again when I get home and don't push myself much the rest of the day.

I should start setting some walking goals as I have a lot of muscle development needed. So maybe today I feel a little better to write something positive. Thanks everyone for the pep talk and support.

 

[skigirl]

Nancy, you are only a month out-=-let the walking goals for reasonable--half a block for instance. I think you are doing well, no need to panic, you will continue to gain rom for the next few months, but this will be a long rehab, a revision always takes longer than the first tkr. Just grit your teeth and get through it. IN a few months, you will be dancing. Kelly

 

[RestAssured]

Yes Nancy,

Only a month out, please be careful! Thought I could tackle the world by then, and it almost cost me my patellar tendon! Please take it slow and easy. I know your mind wants to move faster, but as you and I both know the knee "is really in charge!"

 

[Bill's Son]

Nancy, Good Hello.

Because you are located in the Lapaz area I am posting this request specific to your thread.
and ask forgiveness for forum protocol. I am looking for any contact information for my father who is located in Lapaz BCS Mexico. We are needing a referral for a Doctor or Medical facility on the Baja, any information from a member would be greatly appreciated. My father had a hip replacement 6 years ago and needs a specialist in that field due to ongoing pain around his hip and back. I am living state side and have no contacts or points of reference for quality specalists or medical professional service in Lapaz Mexico.
Thank You in advance for your time and consideration.

Bill's Son