Revision TKR Amy8303's LTKRevision Recovery<

[amy8303]

My surgery was on Feb 12. The lcl ligament ruptured, so it made the whole prosthetic loose and unstable. He had to remove the whole thing and put a new one in. He couldn't fix the ligament, so he just removed it too. I came home from the hospital on Thursday.

It has only been a year since my original LTKR, and now I am feeling very discouraged at having to do this all over again. All the gains I had made are all lost.

For the past year I have complained about pain in my knee and feeling like there was something wrong, but the doctor just didn't believe me. He told me I shouldn't be in pain. No one considered that my ligament had ruptured!

I am very down and not sure how to get out of this funk. Thanks for listening.

 

[Jockette]

I’m so sorry you have to start over, I would feel the same way.

I know all about a knee that doesn’t feel right and not getting any answers. My partial will be 2 years next month. I have not “recovered.”

Hang out with us, we all understand and care what you’re going through.

I will leave you our Recovery Guidelines. 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.

 

[ebungalow]

So sorry you’re going through this @amy8303

 

[grandma chris]

@amy8303 I'm sorry this has happened! At least though now you know why it was feeling bad and it will only get better. Hang out with us, there's a lot of help and support here!

 

[Lindylee]

No wonder you're fed up and feeling low. It's hard, but you can't turn the clock back unfortunately. Try to focus on today, one day at a time and maybe plan some little treats for yourself, listening to your favourite music, having your favourite comfort food, reading a book you've been wanting to, have someone come and give you a manicure, whatever works for you until you're more mobile and can enjoy other things. You will get through it, but take care and be kind to yourself in the meantime.

 

[sistersinhim]

Hang out here with us. You'll meet all kinds of wonderful people that want to help and comfort you. Be sure and read the articles that Jockette left for you. They were extremely helpful in each of our recoveries.

 

[maryo52]

You have suffered a loss. For one, something went wrong. Number two, you were not believed. That is the blunt truth. So you've waited a year for something to be done about your pain, and only then did you learn that a ligament had ruptured, and, surprise, surprise, you DID have a reason for your pain.

Did you doctor have an explanation for why the ligament ruptured?

I hope you have ended up with a good outcome this time, but if I were in your shoes, and the way I am, I would need some time to get over all of this.

 

[amy8303]

Thank you all for your kind words and support. Today was a much better day.

 

[Kenello]

I am sorry you are having to do his all again, especially since you were vocal and not believed. You arethrough the surgery at least, and hopefully you can look forward to a better recovery.

 

[Josephine]

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[amy8303]

I have been feeling better, managing my pain, and making good ROM progress. Thanks to this site and its helpful participants!

My question is: Is it normal to be completely numb from my incision down my entire shin? I am not sure if this is part of healing, or if a nerve has been severed. I will be happy to answer any follow up questions need. Thank you!

 

[maryo52]

@Josephine will come around to ask questions and address your shin numbness.

 

[Ilovecruising]

I am sorry you are having to deal with this a second time. I just had a revision on Jan 29, 2019 so I know how frustrating it can feel. As far as numbness in the shin, I did have some after both surgeries. It wasn’t totally numb but when I would rub across it with my fingers, I could tell the normal feeling wasn’t there. The first one pretty much resolved after a few months so hoping this will too.

I have a question on your revision surgery which was due to your ligament rupture. I complained of pain and instability pretty much immediately following my TKA. My OS finally told me several months after my TKA that my ligaments were weak and the only option was to replace my original implant with a hinged knee implant. Just curious if your surgeon used the hinged knee implant or the regular one again? According to my OS, the regular one needs your ligaments to work properly in order for it to work but the hinged one works well even if you have damaged ligaments. Just wondering if your OS told you the same.

Just hang in there and hopefully this one will work great for you. Just take one day at a time.

 

[Jolease]

@amy8303 I feel for you as I’ve gone through the same sort of thing. I had a partial done and new something was wrong as I couldn’t fully go into extension without excruciating pain. Was told x-rays are good. Finally after my crying, complaining he finally said I had an impingement. I had surgery 4 months later to adjust the plate. Things are even worse for me now, again x-rays are good. This time I have quad issues I can’t explain and nerve damage. I go in Thursday for a TKR, 3 surgeries in just over 16 months, and am feeling so depressed, emotional and scared. I pray this will work this time. I won’t be surprised if he finds something going on in there once he’s opened me up. I hope your shin numbness gets sorted and you have a good recovery this time.

 

[Celle]

Just curious if your surgeon used the hinged knee implant or the regular one again? According to my OS, the regular one needs your ligaments to work properly in order for it to work but the hinged one works well even if you have damaged ligaments. Just wondering if your OS told you the same.

@amy8303 and @Ilovecruising
It's most likely that amy's surgeon used s special implant made for when the cruciate ligaments are damaged or removed. It's quite common to do that, and there are two different sorts of implant. Here's an extract from this article, which explains: Knee replacement surgery types and suggested videos

"There are two types of this implant: cruciate sparing and the cruciate sacrificing. This is to do with the two strong ligaments that cross over inside the joint and prevent the femur from sliding off the top of the tibia when the knee is flexed. They also control the bones when some rotational movements are made such as in sports like skiing and football.

Cruciate sparing
This preserves the cruciate ligaments if they are in good condition. The implants have a notch to accommodate them

Cruciate sacrificing
When the cruciates are in poor condition or even ruptured, a prosthesis is used which has a peg on the plastic insert and a notch on the femoral component to take over their functions of keeping the joint stable.

"​

 

[Cementless]

 

[Josephine]

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.

 

[amy8303]

1. pain levels Right now: 2; at night: up to 8

2. Hydromorphone 2mg: 1 tablet only at night if needed.
Meloxicam 15 mg: 1 tablet daily

3. swelling: Between moderate and slight

4. Bend: 130 Flex: 0

5. icing: yes, in the afternoon/evening for about 30 min.

6. elevating: No

7. activity level: I have returned part time to work. I sit most of the day, but need to stand occasionally. I can cook some basic things if I don't stand too long.

8. exercises at home
None. I figure between working, walking up and down my steps at home, PT, and daily living, that is enough extra exercise for me!

At PT
2 times for 50 min.
Treadmill 10 min.
Bike 10 min.
Sit to stand 20x
Heel raises 20x
Quad stretch 20x
Step ups 20x
Toe up step downs 20x
Standing knee curls with band 20x
Laying knee curls with band 20x

 

[Josephine]

1. pain levels Right now: 2; at night: up to 8

That peak at night is a strong message.

2. Hydromorphone 2mg: 1 tablet only at night if needed.
Meloxicam 15 mg: 1 tablet daily

And here is the issue - your medications are inadequate. You are not yet 3 weeks out so you need to be taking your prescription meds as prescribed. You can also take Tylenol 1,000mg 4 times a day as well. But don't depend upon the meloxicam which is an NSAID. These are very low grade pain killers.

3. swelling: Between moderate and slight

Did you see that swelling is a form of pain? I would estimate that your degree of swelling would add at least 3 points to your pain score.

4. Bend: 130 Flex: 0

That's actually quite good for only 3 weeks out!

5. icing: yes, in the afternoon/evening for about 30 min.

You accomplish little or nothing in 30 minutes. Ice for at least 40-60mins and more than 4 times a day.

6. elevating: No

You should be elevating this early in your recovery. Elevate when you ice.

7. activity level: I have returned part time to work. I sit most of the day, but need to stand occasionally. I can cook some basic things if I don't stand too long.

You've returned to work already? At 3 weeks? That's far too early!

exercises at home
None. I figure between working, walking up and down my steps at home, PT, and daily living, that is enough extra exercise for me! Good point

At PT
2 times for 50 min - what is this one?
Treadmill 10 min - I would say you don't need to do this
Bike 10 min - or this
Sit to stand 20x - or these
Heel raises 20x - certainly not these with your flexion
Quad stretch 20x - unnecessary
Step ups 20x - also unnecessary
Toe up step downs 20x -unnecessary
Standing knee curls with band 20x - unnecessary but so are the bands!
Laying knee curls with band 20x - unnecessary but so are the bands!

In summary:
change your medications as suggested
change your icing and elevating as suggested
stop your routine of exercising and PT

If you are concerned about refusing to do therapy, you need to read this Saying no to therapy - am I allowed to?

 

[amy8303]

Thank you very much for your personalized advice. You provided very helpful guidelines that I will certainly consider.