Revised PKR to TKR Annies recovery thread R PFK to TKR revision 19/07/22

[Annie N]

Hi Folks,

Well, after an unfortunate 2 1/4 year delay, my revision took place a week ago. It nearly didn't happen after I fell down the stairs at the theatre a week beforehand and added a left foot avulsion fracture of the navicular bone to my list of injuries.

Consequently, I turned up to surgery wearing a fetching surgical boot, which caused no end of fun - the surgeon's face was just priceless.

My left revision is definitely loose and unstable, so there's been a lot of conversation about avoiding another of these wobbly knees, and I suspect someone tried very hard with this surgery. Possibly this is why I'm so heavily bruised [from top of thigh to instep], maybe that is also why the right side of my new knee twanged painfully after a few days' recovery. Either way the bruising, and the swelling throughout my leg is adding to the pain factor, which is a shame.

The physio prescribed is of course nigh on impossible to do with a surgical boot, maybe a good rest accompanied by some gentle walking might be for the best in any case.

It's another week before the hospital physio review, time to enjoy the lovely weather and the warm garden.

 

[Layla]

Welcome to the healing side!

turned up to surgery wearing a fetching surgical boot, which caused no end of fun - the surgeon's face was just priceless.

You certainly know how to make an entrance!
I‘m sorry to read of the foot fracture right before your revision. Wow, so unfortunate. I wish you comfort for both knee and foot as you begin healing.

Knee Recovery: The Guidelines

As you begin healing, please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.


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 these pages on the website
Oral And Intravenous Pain Medications
Wound Care In Hospital


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 a 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 history before providing advice.

 

[Jockette]

maybe a good rest accompanied by some gentle walking might be for the best in any case.

This is the way to go even without a foot injury and boot. You won’t be sorry.

Best wishes!

 

[Annie N]

Here's an update.
This week was 6 weeks post surgery and 7 weeks post foot break, so I'm out of the surgical boot and wobbling around a bit, but improving every day. I can walk better still with a crutch or a stick if it's not too far, but also without either short & level distances, and this gets better every day. I can stand far more easily to work in the kitchen and in the garden, so I'm a lot happier. It has been a bumpy 6 weeks.
And I'm contemplating when I will be good enough to cycle up and down the road, possibly another week or so, don't want another fall!
However, I still get a hot knee, particularly in the evening, and still have pain enough to warrant some painkillers. Pretty sore in the foot and knee still at times. It's clear I have some ligament issues in the broken foot.
Went back to physio and to see the surgeon. ROM seems to be 120/125ish depending on the day, and all seem to be happy despite the fact that I'm a couple of weeks behind expected recovery. The exercises can be done but only sometimes so that's when I do them, but I'm getting frustrated so went to Aqua Physio which was amazing, made me smile and much more mobile. Daily routine is getting so much easier, and I'm focussing on that first.
However, I also have more information about my surgery and I now have a decision looming, what do I do about my left wobbly and hyperextending 2019 left replacement?
The choices are mine:
1. Leave as is and use the right as my main balance and support [It's already working better at times]
2. Have the left plastic spacer replaced for one that is larger and is thought that it should reduce or control the hyperextension.
3. Go nuclear [surgeon's words] and replace the 2019 joint again with one that matches the new right knee. The left knee still has a poorly functioning anterior cruciate ligament, the right does not, as the joint itself now does that work. It would be replacement of the top part of the knee replacement only, but still another revision.
It's my choice, I'm not being guided at all what to do here. I'm 64 and active, how do I make this choice? Once made, this will be scheduled in a couple of months, maybe completed this winter. I really want to get back to 100% and on with my life. It's been 10 years now I've been going to and fro to have knee surgery and reviews, never been discharged! If I do go nuclear, this will be my 5th and last for a good while. What should I be thinking in making that decision? Is leaving it or only changing the spacer going to lead to early wear and an early revision anyway?

 

[Jaycey]

@Annie N You have a tough decision to make. It's hard to say what might work best. My gut feeling is that I would go for option 3. Replacing the implant with one that matches the right knee may indeed address the problem that you are still having.

There are no guarantees with any surgery. What does your surgeon say about the level of success you might see after this procedure?

 

[Annie N]

Here's an update, after this I'm moving back to the pre-op forum as the left knee decision has been made
Good news, nearly 5 months and I'm 80-90% recovered from my right knee revision. I'm still a bit weak in the muscles, but I was pretty poor beforehand, so overall it's good, and I'm getting much better use from my right leg and feel a fair bit more stable. Yippee.

Reasonable news - Left knee decision is now made, and I will have a revision to a posterior stabilising implant. It's a difficult decision, as a spacer replacement could very well sort out the issue, but it will not resolve the weakened ligament and maybe not fully address the quite substantial instability that has been demonstrated to me [the knee bends in several directions it's not supposed to!]. If I go with a new spacer, I could be back for a full revision anyway, not a great thought.

However, whilst the surgeon and I lean towards this solution, we don't get the final say. At 3 years, it's an early failure and one he's not experienced before, so it's difficult to predict what's best. All revisions apparently have to go to a multidisciplinary committee to discuss, and this needs approval first. I'm told he is likely to consider doing PFJ revisions to posterior stabilising in future as standard. It is normal for things to go awry for me, so I'm not casting blame, these things can happen, but I don't need to keep falling & I need better balance, so it needs addressing, but it's going to affect 2023 for me, & the wait for surgery has turned into 6 months recently.

Not so good news, my left foot fracture in July was only one of the foot injuries I had, the other was not found at the time. This is now in course of diagnosis finally, snails pace but ho-hum. It's becoming clear that I've got a degeneration in a foot tendon, as I'm unable to walk normally still, and it is painful, this matches the same injury in my right foot back in 2007, very depressing [all because my right knee surgery was delayed a further 3 weeks as well]. If it is confirmed, the solutions will depend on severity, but I know what's coming, and it's not funny & makes a knee replacement look like a walk in the park. I suspect this may need to wait whilst I get my knees fully functioning. Unfortunately, these linked foot/knee issues are a result of being knocked kneed and flat-footed for so many years without the protection of orthotics.

 

[Jaycey]

@Annie N So sorry you are facing more surgery. But it does sound like your surgeon is exploring all the options for you. Fingers crossed this revision does the trick!

Any idea of how long you might be waiting for the op? So many here in the UK are on very long wait lists.

 

[Annie N]

5-6 months is the quoted wait. It has also had to be reviewed by their MDC as this issue is an early failure. The MDC sent me a letter about their decision that's so vague I've no idea what's was decided!