TKR Interpretation of x-ray

[Peoniesazalea]

Although this is my first post, I have been reading the forum for several months and have gained a great deal of insight and information about knee replacement surgery and recovery - much more than what I knew on the actual day of surgery. Reading the experiences of people who have been through the same thing has been incredibly useful and comforting, knowing that I am not alone/without understanding on this journey. Thank you.

I had a LKR on June 16 so am just over four months out. For the most part, things were going great. I had at-home some physical therapy after surgery and when that finished I was able was to continue the exercises on my own and walk a decent amount most days with the use of a cane. At just under three months I started to experience soreness and aching pain on the inside of my knee, at the beginning mostly on the inside below the knee, now mostly on the inside above the knee and into my thigh as well as some on the kneecap. I slowed down on the exercises for a bit and when it felt better I started up again, which resulted in pain/soreness when I move the leg in a certain way. At this point I cannot do leg lifts at all nor can I lift/push my leg forward while sitting in a chair or get in bed without assistance. Heel slides are somewhat doable, but difficult. Walking is doable, but at times I can move the left foot only enough to meet my right foot, not past the right foot to move forward. Bending my leg backwards and doing marching steps and mini squats are fine, as is standing. The only thing I can think of that would have a connection to the problem is a few days before it started I practiced climbing stairs using a 3” step stool. Other than that I was not having much pain or any serious issues.

At my four-month check-up with my surgeon he told me the problem is caused by muscle weakness. My x-ray showed no problem with the implant other than some patellar subluxation that did not worry my doctor. While I am overweight and was not in good shape prior to the surgery, I did not have the current pain and limited mobility until September when it seemed to happen all,of a sudden. My doctor said to go back to exercising and see him again In two months for another x-ray and exam.

i am wondering if any of you have had a similar problem or have any insight into what can be wrong. While I have no reason not to trust my surgeon, I can’t help but wonder why muscle weakness of this magnitude would occur at three months post surgery and he did not offer any reason. I feel like things were going so well and now I am going backwards rather than forward. I’m worried about permanent ’damage.’

Marie

 

[Jockette]

Hi and Welcome!

I’m not sure what can cause this suddenly, unless you maybe really overdid the step practice? I had quite a setback when I was 4 months post op, by overdoing an activity repeatedly, over a 3 day period, and it took me a month to recover from it. Hopefully things will improve again soon.

Even though you may have read our Recovery Guidelines, here’s your own copy. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

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

​

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

6. Access to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

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 the 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 the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[Peoniesazalea]

Thanks @Jockette. I am reading your recovery thread now.

 

[Roy Gardiner]

I’m worried about permanent ’damage.’

You won't have damaged the implant - it's very strong! - and soft tissue damage, if any, can heal. As the guidelines say, just don't do stuff that hurts, and push for progress slowly and gently.

 

[Peoniesazalea]

Thanks for the encouragement @Roy Gardiner The implant itself does feel strong; it is the strain/pain when moving or using any of the muscles in that area (quads and inner side of knee/leg) combined with the inability to lift the leg that are concerning. I will exercise as the doctor recommended but plan to take it very slow and see if there is improvement. I could do leg lifts and heel slides before and get on the bed by myself until one day I couldn’t. This seems strange to me.

i have read your information about using an exercise bike. We have had one in order for ten weeks. Hopefully it arrives soon so I can give that a try. Don’t want to overdo, but also don’t want the muscles to wither away.

Thanks again!

Marie

 

[Moriah]

I was told I have muscle weakness as well. I was given some exercises that focus on each of the muscles that are weak. Be careful though, do only a few at a time until you know if you have pain. Discomfort will appear hours later so don't over do it.
I would guess that your activity increased and you hit a certain point where the weakness is an issue. If I overdo, I can go through several days of log leg, weakness, swelling and pain.

 

[Geoffa]

Marie,
Below is some words from the Abstract of a Meta Analysis about muscle strength following TKR.


During the year after TKA, quadriceps and hamstring muscle strengths were lowest after 3 months, recovering to preoperative level after six months, but not reaching the muscle strength on the contralateral side. Relative to preoperative levels, the difference in muscle strength between the TKA and contralateral knees was only significant at three months. Because decrease of strength of the quadriceps was significantly greater than decrease in hamstring muscle strength at postoperative three months, early rehabilitation after TKA should focus on recovery of quadriceps muscle strength.

If you wish to read the whole article it is available @ Serial Changes of Quadriceps and Hamstring Muscle Strength Following Total Knee Arthroplasty: A Meta-Analysis
This is the link to the article: https://pubmed.ncbi.nlm.nih.gov/26849808/

Young-Wan Moon et al. PLoS One. 2016.

Your observations are supported by analysis.

 

[Peoniesazalea]

Since the last visit with my surgeon a little over a week ago I have been doing some of the exercises I was previously doing during physical therapy. I am taking it slower than I was earlier with fewer reps and not doing all of the exercises in one day. I also walk some with a cane (don’t use the cane in the house). I think there may be some slight improvement, but I am nowhere near where I was before things went bad, I still cant do a leg lift and heel slides are difficult but doable after warming up. Our recumbent bike should arrive any day and once assembled I will get started with that.

Hope everyone is doing well this weekend. Even with this setback I still believe I will get to a point where I feel the surgery was 100% worth it. Hope you all feel the same way and are making positive progress on this journey.

 

[sistersinhim]

You are just through 1/3 of this year-long journey. You will have ups and downs for quite a while yet. Taking it easy will be a big benefit to you. You will get there in your knee's timeline.

 

[Peoniesazalea]

Thank you @sistersinhim. I appreciate your support.

Marie

 

[dlssimon]

I had my LTKR done on June 12th, just a few days before you. Around 3 1/2 months I had a general ache all around my knee 24/7. I had been doing so good that I got back to my routine and apparently did way too much. This forum told me to slow down and give it the year that it takes to recover. So I followed their advice and am taking things slower, icing and resting more. The ache is still there but not as bad. This forum is great for people like me that had no clue what I was in for getting my knee replaced. Good luck and take it easy!!

 

[Peoniesazalea]

Thanks @dlssimon Like you, I did not know what to expect after the surgery. I was told the surgery and aftermath is very painful, but pretty much clueless on the details of what was done and what to do when with regard to physical therapy, general exercise and so on. I have learned a great deal from this website. Still plugging along with light exercises and walking and am now using a recumbent bike. if it were not impossible to lift my leg to get in bed and the ache getting out of a chair, I would be feeling pretty good.

 

[Peoniesazalea]

What is it called when your leg, from your knee down, does not move up/forward when sitting in a chair?

 

[Celle]

Do you mean you can't straighten your leg when you're sitting in a chair?

 

[Peoniesazalea]

@Celle I can walk fairly well, do marching steps, use a recumbent bike and bend my leg backwards. I have difficulty lifting my leg onto the bed, can barely if at all do a leg lift while lying down (my leg does lay straight) and if i am sitting in a chair cannot lift my leg up and move it out/forward. I can slide it forward, but not lift it up and kick it out so to speak. I also have to pull my leg to get in the car, rather than it lifting on its own. Thank you for nay insight you can provide.

 

[Celle]

It sounds as if you have quad lag. The nerve that activates your quad muscles isn't firing properly yet.
You need to talk to your surgeon about this.

 

[Peoniesazalea]

Thanks @Celle I will talk to him again. He previously thought it was muscle weakness. What I find strange is that the quads were fine in terms of their progress until I hit three months; that”s when the problem started.

 

[Jockette]

the quads were fine in terms of their progress until I hit three months; that”s when the problem started.

What are you doing different since this time? Have you gone back to work, or started an increased exercise program? More stairs than before?

 

[Peoniesazalea]

@Jockette The only thing I can connect to the loss of function in the quad was I used a 3 inch step stool for two days to practice going up stairs. The first soreness and lack of function occurred a day or two after that exercise. Once I lost the use of the quad I slowed down on the exercise and then when it started to feel a little better I would do some of the exercises again - not as many as before, not as often and not as many reps. Another possible impact is that my husband and I took a trip where we drove 10 hours a day for two days there and two days back. I was the passenger and did not drive. While on that trip my knee and the leg on the inside of the knee and above got very bad to the point where it was very difficult to walk and I found myself dragging the foot on the leg that had the TKR. It is no longer that bad functionality or pain wise.

At my last visit my surgeon thought the problem was muscle weakness as there is nothing wrong with the implant and although the x-ray showed patellar subluxation he did not feel it was enough to warrant worry. Since that visit three weeks ago I have done some exercise - marching steps, standing on one leg and lifting the other to the side/to the back, bridges, clamshells, and bending my knee backwards while standing. I do some walking, but not as much as I was before the problem. For the last couple of weeks I rode 25 minutes on a recumbent bike most days, without a problem except for pain getting up from the bike when done riding. I can do heel slides after warming up, but they are a challenge. Full and partial leg lifts are not happening right now. Except for soreness/minor pain getting out of a chair and in the morning after laying in the bed all night in pretty much one position I do not have pain.

i guess I am trying to find out if this kind of setback at this point in the healing process is abnormal or common or..... Is there something specific I should ask my doctor? He told me exercise would not make the problem worse and is needed to strengthen the quad, but I worry that since there is still pain at times and not much improvement I am doing too much or not enough, or not addressing the actual problem. Except for this problem the new knee seems fine.

Thank you for your time and advice!

 

[Geoffa]

Peoniesazalea,
You raise an important consideration, I have had a good recovery but always had quad muscles as the limiting part of my recovery.
At my 3 mth OS check up I noted my only concern in recovery was my quads. He explained that was completely normal because the surgery cut thru the rectus femoris to access the knee capsule.
I always thought the two quads you could see were the issue, he said no it was this big muscle that was the problem, then he compared left with right and pretty much on my surgical knee there was not much there.

His only advice for recovery was ADL. During ADL as aggressive as I make my day always issues relate to this muscle.
Interesting my GP shared a similar view and was not supportive of any special weight program.
Hope this helps.
Geoff