Revised PKR to TKR Agilitymom's revision recovery<<

[sistersinhim]

You're still really early in your recovery, not even 1/6 of the way through the year it takes for the soft tissues to heal. Pain and swelling is pretty normal at your stage, unfortunately. Ice and elevate as much as you can. That should help with the pain and swelling. Also, keep your activities down until the pain and swelling diminishes. If it hurts and swells then your knee isn't ready for it.

 

[agilitymom]

I was told by PT that icing at this point is not necessary and that it will hinder recovery. I am no Dr but does this make sense to anyone?

 

[Jockette]

Some surgeons say to ice, other surgeons say not to. So, choose what works for you. If you think it helps, do it.

Bonesmart highly recommends it, for 45-60 minutes at a time, and at least 4 times a day, if you have a lot of swelling. Just be sure you have a towel or something, between you and the ice/cold source.

I iced for up until about 6 months post op.

 

[kmak81230]

My PT does not think it helps with healing much as it is hard for the cooling to reach the deep tissues, but recommends it for discomfort and pain relief and that's what I use it for. I find it very helpful for that purpose. I had another PT tell me once that it inhibits circulation which is good for healing. . . . who knows? My philosophy is if it feels good, then ice.

 

[Josephine]

I am now using Tylenol, Motrin

What doses are you using and how often do you take them?

I was told by PT that icing at this point is not necessary and that it will hinder recovery. I am no Dr but does this make sense to anyone?

It makes no sense at all. How does she know if it's necessary or helpful or not? Utterly daft!

 

[Celle]

I was told by PT that icing at this point is not necessary and that it will hinder recovery. I am no Dr but does this make sense to anyone?

Some surgeons say to ice, other surgeons say not to. So, choose what works for you. If you think it helps, do it.

My PT does not think it helps with healing much as it is hard for the cooling to reach the deep tissues, but recommends it for discomfort and pain relief and that's what I use it for. I find it very helpful for that purpose.

It's your knee and you have the right to decide.
Do what feels good for you and your knee.

 

[agilitymom]

What doses are you using and how often do you take them?

I am taking 500 mg extra strength Tylenol times 2 every 8 hours. I am taking Advil, don’t have the package with me, 1 every 8 hours. Icing helps. My main pain source is behind my knee when walking and inside front part of my knee.

 

[Josephine]

I am taking 500 mg extra strength Tylenol times 2 every 8 hours.

Should be 6hrly.

I am taking Advil, don’t have the package with me, 1 every 8 hours.

I wouldn't take those if I were you. Apart from being a very poor pain killer, they also have some side effects, like these
Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers
NSAIDs Diclofenac. ibuprofen increase risk of heart problems: new study

My main pain source is behind my knee

Have you tried icing that spot?

 

[agilitymom]

I am icing it about 5 times a day. Problem is if I walk more than a minute I get terrible pain increasing with each step.

 

[agilitymom]

I am now 4 months post revision surgery. Had an MUA 3 weeks ago and went from 80 degrees flexion to 110. Have kept that up to this week. My knee is super painful and lightly swollen all the time. I have seen a new PT and he thinks that I may have another problem with this appliance. He thinks it is possibly too large. I am in constant pain with each step and have slight swelling all the time. He says it is in the knee and that means it is in a capsule and the fluid has nowhere to go so it will continue to swell until it dissipates. Joy. He has suggested I get a second opinion from a civilian revision specialist. What do you all think? My first Dr. for both surgeries was a Navy surgeon.

 

[Jockette]

I’ll tag @Josephine for you.

 

[zab]

Sounds like you are having a torrid time of it, I really hope things start to get better for you.

 

[Josephine]

he thinks that I may have another problem with this appliance

What appliance? I've just read through your thread and there is no 'appliance' mentioned!

He has suggested I get a second opinion from a civilian revision specialist. What do you all think?

Before I can answer that, I need you to answer my questions again. Are you agreeable?

 

[agilitymom]

Josephine,
Yes I will answer your questions. Also he was calling the new knee replacement parts appliance.

 

[Josephine]

Oh, okay!

Here y'go then!

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. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

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.

 

[agilitymom]

@Josepine, here are my answers. Very late,but I have been traveling and then the flu. Ugh!

1. Pain level is 0 if elevating. 4 during regular daily activities and goes up to a 5 or 6 when sitting longer than 30 minutes, standing longer than 10 minutes and walking longer than 10 minutes.

2. Tramadol 50mg as needed. I try not to take these as I get very drowsy and can’t stay awake. I take Tylenol 3 times a day and I use a combo of Frankencence, Tumeric and Copaiba oils twice a day for pain and inflammation.

3. I am slightly swollen constantly. My knee is also very warm to touch. When icing it never cools down on front of knee.

4. ROM is 110. Flexion is 10, I think. It does not straighten.

5. I ice and elevate at least 3 times a day. Icing for at least 30 minutes, however it does not cool my knee on top or front.

6. I elevate at least 3 times during the day. At night I am usually watching sports and my leg is elevated during that time.

7. My activity level is low compared to my normal, at least prior to knee problems. I am retired but work as a human part of a K-9 search and rescue team. I cannot do that so very little dog training and no hiking. I do all the inside housework but am not very diligent. I also cook most meals but am super lucky that my hubs will take over when I am not doing well. I also do most shopping but that is not much. Sitting at the computer is done in 30 minute shifts as it really hurts to sit longer than that.

8. Exercises at home:
Heel slides x 10
Leg extension with heel on coffee table and letting gravity try to straighten leg- 5 minutes
Clamshells x 10
Squats x 10. (Very tiny ones)
Side lying straight leg extensions x 10
I do all these twice a day.

I also walk my dogs once a day for about 1/2 mile. Then ice and elevate immediately.

On another note, I just had a second opinion from a surgeon outside the Navy. He was so different and helpful. He had reviewed my records and xrays beforehand and the first thing he said was that I was not crazy and that in his opinion there is some micro movement of the implant. He also said that he could see some space between the implant and the bone. His first concern is infection so I did blood draw yesterday. Am scheduled for a bone scan and he wants to possibly aspirate my knee to check for infection. He comes highly recommended as a knee surgeon that works on revisions.

 

[Celle]

I'm glad the surgeon you saw for a second opinion was so helpful.
Do you have a copy of the X-Rays he took? If so, it would be helpful if you can post them, for Josephine to look at.
A few tips on posting xrays

 

[Josephine]

4. ROM is 110. Flexion is 10, I think. It does not straighten.

I think you have fallen into the trap of thinking that ROM applies only to flexion. It does not. Range of Motion includes bot flexion AND extension, as I explained in the question. So you answer is very confusing: You said flexion is 10 but that is bend. And that ROM, which I suppose you meant to indicate extension, cannot possible be 110.

Here is a graphic to show you how it works

 

[Josephine]

@Josepine

In order to make a tag work, the name must be spelled correctly! And after you've posted it, if the tag does not turn blue, then it's been done incorrectly. In this case, you left the 'h' out of my name!

he said was that I was not crazy and that in his opinion there is some micro movement of the implant. He also said that he could see some space between the implant and the bone.

I'm sorry to hear that. Currently suffering from a loose implant myself, I can sympathise.

1. Pain level is 0 if elevating.
4 during regular daily activities
5-6 when sitting longer than 30 minutes
also when standing longer than 10 minutes and walking longer than 10 minutes.

Interesting. I also find that activity has a lower pain score than sitting. Can't yet figure out why but it's a fact!

2. Tramadol 50mg as needed. I try not to take these as I get very drowsy and can’t stay awake. I take Tylenol 3 times a day and I use a combo of Frankincense, Turmeric and Copaiba oils twice a day for pain and inflammation.

A loose implant has the same impact as arthritis - NO pain meds will subdue it!

3. I am slightly swollen constantly. My knee is also very warm to touch. When icing it never cools down on front of knee.

Yes, everything's kapoo-ey when an implant is loose. What works for post-op, definitely does NOT work for a loose implant.

5. I ice and elevate at least 3 times a day. Icing for at least 30 minutes, however it does not cool my knee on top or front.

I've never found icing helps in any way at all.

6. I elevate at least 3 times during the day. At night I am usually watching sports and my leg is elevated during that time.

However, elevating does help, particularly after a heavy days shopping!

7. My activity level is low compared to my normal, at least prior to knee problems. I do all the inside housework but am not very diligent. I also cook most meals but am super lucky that my hubs will take over when I am not doing well. I also do most shopping but that is not much. Sitting at the computer is done in 30 minute shifts as it really hurts to sit longer than that.

That could be description of my life except for the hubby!

Exercises at home:
Heel slides x 10
Leg extension with heel on coffee table and letting gravity try to straighten leg- 5 minutes
Clamshells x 10
Squats x 10. (Very tiny ones)
Side lying straight leg extensions x 10
I do all these twice a day.

I strongly recommend that you don't do exercises. If your implant is loose that's the very worst thing you could and very much accounts for much of the pain you are experiencing. Being active/doing exercises means that you are causing the implant to toggle in the bone, hence causing more pain. Neither is there anything to be gained by doing them.

I also walk my dogs once a day for about ½ mile. Then ice and elevate immediately.

Yes, sometimes we do what we gotta do - isn't that the case! Our furry friends need to be looked after so I doubt this will be a deal breaker!

In summary:
1. remember that no pain meds work very well when there is a loose implant
2. quit the exercising, pronto!

 

[Celle]

Had an MUA 3 weeks ago and went from 80 degrees flexion to 110.

@agilitymom - You posted about your MUA back in February, but we don't have the date you had it done.
Please will you tell us that, so we can add it to your signature? Thank you.

When you have an MUA it actually sets back your recovery for a while, as your knee tissues are re-injured. We usually advise to start counting your healing period from the date of the MUA.