Revision TKR Against the wind

[Josephine]

Don't ever use pain meds to enable exercising. Pain has a very important function which is to tell us when things are too much for your knee. If you don't have that signal then you over do it and end up with the kind of long term pain that throbbing leg.

 

[skippyhak]

Knee started getting very sore, swelling and stiffening after hiking. That was one month ago. Extension is about 15 degrees.....rom maybe 120. Dr. injected knee with cortisone. Back in PT and very slow progress. Stiffening and tightness is severe at times and knee has become unstable. Slight improvement as I work to strengthen knee. Feedback and suggestions for plan of action. Thanks!

 

[Pumpkin]

skippyhak,
Welcome back, sorry you are having trouble with your knee.
You need a second pair of eyes looking at your knee.
Suggest you get a second opinion, your knee should not be suddenly unstable.
Find a surgeon who specializes in revisions or complex knee reconstruction, they have the education and experience to determine what is going on with troubled knees. They should have no relationship with your present surgeon, not even golf buddies.

 

[Celle]

Hi @skippyhak
I'm sorry you're having problems again.

I'm going to ask @Josephine to advise you.

By the way, you'll notice that I have merged your newest thread with your original recovery thread. For several reasons, we prefer that you only have one recovery thread:

• That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
• If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
• Having only one thread will act as a diary of your progress that you can look back on.

So please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we'll get it changed for you.
If you need an urgent response to a question, just tag a member of staff. We do read all the new postgs every day.
How to tag another member; how to answer when someone tags you

Here are the instructions on finding your thread, How can I find my threads and posts? . Many members bookmark their thread, so they can find it when they log on.

 

[skigirl]

I would be leery of having injections into that new joint. There is a huge potential for infection---I hope he did the steroid injection under strict sterile conditions.

 

[Josephine]

Feedback and suggestions for plan of action.

I take it you would be willing to answer a 'few' questions!! I'd like you to answer these in regard to what you have been doing in the last 6 weeks.

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine)

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[skippyhak]

Thanks to everyone for your posts.... very helpful and reassuring.

I've had 10 PT sessions and have exercised at home in between. My leg feels stronger but the swelling and inflammation are essentially unchanged. About every 4 or 5 days I'll have a knee "episode". The episode, I'll describe it as best I can, leg starts stiffening up and cramping severely. When this happens I cannot walk it off. Very difficult to get out of car because knee will only bend so far before pain becomes unbearable, if I hang my leg off the edge of the bed and let it straighten for 5 minutes or so it lessens the symptoms enough that I can walk around using a cane for support. It takes 24 hours to be able to walk without a cane around the house. After these episodes the knee has increased swelling and soreness. This last for 2 or 3 days until it goes back to my "normal". My current activity level is greatly reduced; mostly light housework and yard work, grocery store....pretty sedentary lifestyle.

I'll now answer the list of questions.
1. Pain levels 1 or 2. 4 to 6 during "episode" periods.
2. Pain meds 325-5 Percocet. 650mg Acetaminophen. Percocet 1 to 3 tabs per week. 4 tabs daily.
My pain is related to motion or activity. Sitting, my pain negligible. Going down stairs pain is 4 to 5.
3. Swelling moderate.
4. ROM 115? Guestimate. Greatly reduced during a stiffness/cramping "episode". ROM has not been an issue.
extension is 15 degrees.
5. Icing 4 times per day for 15 minutes each time.
6. Elevating...not really. Sit in recliner but knee not above my heart.
7. Light housework, yard work, shopping. Not walking, hiking, golfing.
8. Exercises. Bike 6 to 10 minutes per day. Hang legs off bed 2 times per day 5 minutes each time. 5 lb. wt. on knee for 5 minutes 2 times per day. Calf stretches each day. Hip flexor stretch each day. When I've had episodes I've only hung my legs off the bed, 1 or 2 times. 3 days a week I add in 4 exercises with bands and wt's.
9. PT was terminated today. No progress after 10 sessions. Saving PT in the event of a revision surgery or something.
Hope this makes sense.
Thanks!!

 

[Josephine]

Before I get to your answers, I'm somewhat confused. All you answers appear to pertain to a relatively new knee yet I see nothing in this thread about a surgery more recent than June 27, 2016. So what's afoot? Is this knee 10 months old or have you had a more recent one?

 

[skippyhak]

No new surgery. This is a 10 month old knee.

 

[Josephine]

Cool - thanks

I've had 10 PT sessions and have exercised at home in between. My leg feels stronger but the swelling and inflammation are essentially unchanged. About every 4 or 5 days I'll have a knee "episode". The episode, I'll describe it as best I can, leg starts stiffening up and cramping severely.

Yep, that pretty much tells me everything!

1. Pain levels 1 or 2. 4 to 6 during "episode" periods.

okay

2. Pain meds 325-5 Percocet. 650mg Acetaminophen. Percocet 1 to 3 tabs per week. 4 tabs daily.

You're still on Percocet after 10 months?

3. Swelling moderate.

Not good

4. ROM 115? Guestimate. Greatly reduced during a stiffness/cramping "episode". ROM has not been an issue. Extension is 15 degrees.

I'm not sure you understand ROM very well. You say ROM has not been an issue but that your extension is 15 degrees. Is that +15 or -15?

This explains how ROM measurement works

5. Icing 4 times per day for 15 minutes each time.

You accomplish little or nothing in 15 minutes. Ice for at least 40-60mins and more than 4 times a day.

6. Elevating...not really. Sit in recliner but knee not above my heart.

That's not the crucial issue now. Just have it up off the floor. On the settee will do fine.

7. Light housework, yard work, shopping. Not walking, hiking, golfing.

Really? Is that all you can manage?

8. Exercises.
Bike 6 to 10 minutes per day.
Hang legs off bed 2 times per day 5 minutes each time. 5 lb. wt. on knee for 5 minutes 2 times per day.
Calf stretches each day.
Hip flexor stretch each day.

When I've had episodes I've only hung my legs off the bed, 1 or 2 times. 3 days a week I add in 4 exercises with bands and wt's.
9. PT was terminated today. No progress after 10 sessions. Saving PT in the event of a revision surgery or something.

You are still doing all these at 10 months out? Why?

I think you should stop all exercising. It's likely it is this that is causing your swelling and pain and therefore limiting your ROM. It will only improve if you stop it all and allow the swelling and pain to subside.

To give you a worst case scenario about the situation you are in, please read this. It's scary but it will show you what can (note I said 'can', not 'will') happen if you don't change things now. PT: the seriously grave consequences of doing too much of it

 

[skippyhak]

If I stop all exercises should I also limit walking to bare minimum? What's a reasonable amount of time to wait for swelling to dissipate?

 

[KarriB]

Let's tag @Josephine because she's just has her own surgery this week and I'm not sure when she'll be by. But I'd say to follow Jo's recommendation to stop all exercises, keep your leg up as much as possible and it couldn't hurt to keep walking at a minimum for now. I'd say anytime you're sitting elevate and ice for an hour to get the swelling down. It may take a few weeks.

 

[skippyhak]

Thanks....I'm going with total rest..I'm seeing what happens with 3 weeks of rest ice and elevation.
Thanks

 

[Josephine]

If I stop all exercises should I also limit walking to bare minimum?

Follow the guidelines in this Activity progression for TKRs.

What's a reasonable amount of time to wait for swelling to dissipate?

I'm afraid this is what I generally refer to as a "how long is a piece of string" question!

 

[skippyhak]

Thanks. I re-read activity progression to apply to my current situation. My leg is very clear AFTER I do too much. I'm not clear on what's too much until after I do it. If too much on my feet, too much walking over a couple of days and then, WHAM, another episode of extreme stiffening, followed by increased swelling and pain. No pain if sitting in chair with leg elevated. Sitting with leg bent, walking, stairs etc. all have increased pain levels. Takes about 48 hours of sitting and resting with leg elevated to get leg to return to baseline. My baseline is .... maybe about like 10 weeks post TKR? Pretty discouraging being 11 months since replacement. I'm about 7 weeks since all this started and no progress. I'm really hoping that going to a very low level of activity might get the inflammation and swelling to reduce but one week and no improvement.

 

[Celle]

When you've had chronic swelling, it can take as long as 3 weeks of rest before you see any improvement.

 

[skippyhak]

Thanks Celle......my current timeline was keeping activity minimal for 1 month. And see if I get improvement with swelling, stiffening stability etc.....here's a question????.... my leg is still bent. Best I've gotten it to is 12 degrees (extension). If they do a revision surgery can they get the leg straight or is a bent leg my fate?
Thanks

 

[Celle]

When your leg had been bent for a long time, the muscles and tendons at the back of your leg will have shrunk. It takes time and gentle treatment to help them stretch out again. It's unlikely to be any mechanical problem inside your knee that is preventing your leg from straightening, so I don't think surgery will help much with your leg's extension. That doesn't mean I disagree with getting a second opinion.

If you choose one or two of the exercises in this article and do them gently, over a period of months your extension should improve. I don't think you should do the exercise with weights yet. Don't expect quick results.
Extension: how to estimate it and ways to improve it

 

[skippyhak]

Thanks! Been doing heel slides, only, over the last week. Going very slow at moment to see if I can stabilize and decrease the "severe stiffening" episodes. Each episode brings increased swelling and takes about 48 hours to return to my baseline. I took LEFS exam and scored 32. I was at 55 3 months ago. Not accepting this level of activity and mobility as my fate. Discouraged but hopeful I can find a way back.

 

[Josephine]

My leg is very clear AFTER I do too much. I'm not clear on what's too much until after I do it.

Keep a log! Seriously!

I am very curious though that you have all these problems after almost a year! Are you sure you've told us everything?