Knee Infection* Anxious about 2 stage revision

Demelsa

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Hi All,

I am so glad I have found this forum. I had my left total knee replacement on 15th January 2021, after years of bone on bone pain, and the surgeon said it all went well. When I came around fully back on the ward it was very painful but I had expected this and was well medicated. I was helped out of bed to use the bathroom later that evening and was mobilised again the next morning when I saw the PT. The leg was very swollen and the knee would only bend to 60 degrees when I was discharged home the following day.

The problem is at 3 months I still don't have any more of a bend. The knee seems to lock solid once its bent as far as it will go. I had 6 weeks of face to face PT and saw the surgeon for review at 6 weeks. He scheduled a MUA for the 29th March (11 weeks post TKR) to try and get a better range of movement. I had. a spinal block for the MUA so was fully conscious while it was being done. The surgeon declared that he was unable to get any more than a 60 degree bend on the knee so it looked like I was "in it for the long haul"! He then administered a steroid injection into the knee to see if that would help.

I am back and home and totally disheartened, the knee is still swollen, there is a little discomfort but no major pain. At this point I really wish I hadn't had it done, I am unable to drive so have totally lost my independence and I am not seeing any progress at all in my recovery. The PT I saw briefly after the MUA suggested I may need keyhole surgery next. I find the idea totally overwhelming, I am not due to see the surgeon again until July.

Thank you for reading this, any suggestions would be very much appreciated. I am 55 and was really looking forward to becoming pain free and mobile again. This really isn't where I had thought I would be. I am due to return to work next week, which I am able to do from home due to the pandemic.
 
:welome: to BoneSmart

'Total stop' to bend is usually caused by adhesions, where soft tissue sticks together post-op. This is not to be confused with scar tissue, which always forms and isn't an issue of itself.

MUA is designed to 'snap' the adhesions an allow greater ROM.

My personal view is that you need to find another surgeon to look at your knee, one who specialises in revisions (that is, fixing knee surgery that didn't work) and who has no professional or personal contact with the original surgeon.

Is the suggested keyhole surgery to cut the adhesions? It's something worth looking at. Can your PT recommend a surgeon?

'In it for the long haul', i.e. disabled, is not acceptable. There will be a solution somewhere, I believe.
 
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Hi Demelsa,

Arrgh! I understand your dismay and worry! I was you about five years ago. I also did not recover my bend very quickly either, and like you, was threatened with what I called the “Dreaded MUA!” I resisted the idea, but it’s because I had found these wonderful people here! In many places in the world, there is not the push for the bend so soon. But over many weeks, gradually the swelling I had went down, I finally got some good pain relief after the pain meds initially given were replaced by things I did not react so badly to, etc. I bet some other very senior moderators here will chime in, so take comfort that you have support here!
I’m not one of the experts but at about 6 months out I did have my bend, after I stopped being pushed by PTs and doctors! I just took longer to get there! My left knee (the one done in 2016) is now my main knee; the other is a good stick mostly.
Hang in there, and you’ve come to a place with lots of support!
 
@Demelsa Welcome to BoneSmart! Have you been icing and elevating that op leg on a regular basis. Ice for 45-60 minutes per session several times per day. Some of the lack of bend is due to internal swelling. Ice will help ease this.
 
Thank you BBCG it is certainly a comfort to know others have been on a similar journey and it worked out in the end. it can feel like a very lonely journey when everything you read talks about great ROM and mine seems stuck.

Jaycey, yes I have been icing a lot. I have a cyrocuff and cooler so I can keep the cuff cold and am using it several times a day. it certainly helps with the swelling on the outside.
 
Demelsa,
My sister’s swelling took a full year to resolve! My left TKR done Jan 25 is still swollen and quite stiff at times. It will come around. Try to be patient and forget about the numbers. And if the problem persists, do get a 2nd opinion.
 
Hello @Demelsa - and :welome:

There is still hope that your knee will begin to bend further as its swelling goes down. It was swollen after your first surgery and the MUA will have caused further trauma and more swelling.

You're only 3 months into a recovery that normally takes a full year, so you have plenty of time for improvement.

There's no need to rush to get ROM (Range of Motion) because it can continue to improve for a year, or even much longer, after a knee replacement. There isn't any deadline you have to meet:
Myth busting: the "window of opportunity" in TKR

Here are a couple of examples from people who had a slow ROM development, but who achieved a good result in the end:

First, from bertschb:
I'm 12 months out from my surgery and have some advice based on my experience:
1- Stop going to PT (all it will do is make your knee swell and reduce ROM)
2- Don't worry about your ROM
3- Be patient - VERY patient!!!

Here is my ROM history (more or less):
1 month - 60 degrees
2 months - 80 degrees
3 months - 85 degrees
4 months - 90 degrees
5 months - 90 degrees
6 months - 110 degrees
7 months - 120 degrees
8 months - 125 degrees
9 months - 130 degrees
10 months - 135 degrees
11 months - 140 degrees
12 months - 140 degrees

I spent waaaaay too much time worrying about ROM. I thought I'd be riding my bike a couple months after surgery but it took SIX months! Looking back on my surgery, if I knew then what I know now, I wouldn't have wasted my time with PT and I wouldn't have worried about ROM.


And now from TortiTabby:
Just an update for those who are apprehensive about gaining ROM:
It has now been 26 weeks and all I do is ADL and this is what my ROM has done:
3.5 wks: 75
6 wks: 85
7 wks: 90
10.5 wks: 95
14 wks: 100
17 wks: 105
20 weeks: 110
26 weeks (where I am today): 120!!!
I did it! My goal of 120! No "pushing through pain", no PT after the first 3 visits, and most importantly to me: No MUA! My surgeon who said I would never get beyond 85 ROM without pushing through pain was wrong, wrong, wrong. I'm excited to see if it gets even better.
:happydance:
 
Roy Gardiner's suggestion to get a second opinion is a good one, but you may find it hard to find someone who will see your knee before a year after surgery.

That's for two reasons. First, surgeons have a sort of code whereby they don't see another surgeon's patients until a year has passed, so they aren't thought to be stealing someone else's patient.
Second, a large number of problems sort themselves out and resolve anyway by a year after surgery.

Keep up with the elevating and icing, and only do gentle exercises. Don't get trapped into thinking that the harder you work, the better your result will be. it doesn't seem to work that way for this recovery.
Knee recovery - Lose the Work Ethic!!
 
I knew you would hear from more of us who didn’t get to the ideal ROM by someone else’s official date!

This time (2nd TKR on Apr. 29) if the PT is too uptight about my ROM, I’ll warn them that I’m not buying it, and it will be there when it’s there! Period. My knee that was so worrisome to others is rock solid and does ALL the heavy lifting and has for 3 years! I wish I had been as diligent as Roy and gotten my ROM at different dates, but I might see if my PT still has those records... at any rate, don’t let them scare you snd worry you! My ROM was probably not to 120 until about 7 months along. And my PT who I still see for other issues finally stopped worrying about it too!

This time I will be curious to see if the PT I have to see the 2 weeks after surgery do things differently... my normal PT who is wonderful, is on a river trip my first two weeks post...
 
My knee that was so worrisome to others is rock solid and does ALL the heavy lifting and has for 3 years!
Exactly!

My ROM continued to improve in my second, and even my third, years post op. It will come as you heal and when your swelling goes down.
 
Indeed! That leg is so strong now, and since about 2018 when Dan was dealing with his first bout with cancer, it’s been on my to-do list. I have so changed my life and activities because of the not-yet new knee!
 
What is ADL? I am 6 weeks post surgery with bilateral and my PT is doom and gloom about my ROM. Hearing what others say is making me feel better. Thinking about stopping PT and just living my life and let it come on it's own.
 
What is ADL? I am 6 weeks post surgery with bilateral and my PT is doom and gloom about my ROM. Hearing what others say is making me feel better. Thinking about stopping PT and just living my life and let it come on it's own.
Welcome to Bonesmart! We’d love it if you would start a recovery thread so we can discuss your healing journey with you.
 
I’ve just passed 4 month since surgery and still only have about 60 degrees bend. It’s really getting me down. Im in a bit of pain and discomfort and spend much of the day with it elevated and icing it to try and address the swelling. I’m selling my little old 2seater sports car as leaving it standing isn’t doing it any good and I don’t feel I’ll ever be able to drive it again. In fact it feels like I’m going to have to start to make some changes to my personal circumstances as many ordinary daily activities are a real challenge.
 
I’m selling my little old 2 seater sports car as leaving it standing isn’t doing it any good and I don’t feel I’ll ever be able to drive it again
Please don't do that, you'll regret it when your knee recovers. What kind of car is it? Pic?

Yes, leaving it standing won't do it any good; but do you have a friend or family member who could drive it a few miles every so often?
In fact it feels like I’m going to have to start to make some changes to my personal circumstances as many ordinary daily activities are a real challenge.
It's a so-and-so isn't it? But there must be a cause, and recovery should be possible. What did your surgeon say after the MUA? Was a full range of motion possible then? Did he have to break adhesions?

MUA is like resetting your recovery date, as it's pretty tough (hence the anaesthetic), meaning you're 'only' abut 6 weeks out now. Has the swelling gone down at all since the MUA?

I found my static bike good for knee stretching, if you have one.
  • Set the bike to zero resistance
  • Set the saddle low enough so that a single rotation is a challenge; difficult but not painful. When a rotation becomes easy right from the start, lower the saddle a max of 1cm.
  • Gently turn the pedals, through discomfort but without pain.
  • Continue until the knee is 'warmed up' and the rotation is now easy, or for 2 minutes, whichever is the shorter time.
  • Repeat several/many times a day, but don't go mad. Diminishing returns will apply; my guess is that half a dozen reps would be enough
  • Do not pedal fast or for more than 2 minutes, this is a stretching exercise, not training.
  • And if you get any pain or swelling in the 24 hours after doing this, cut it down until you don't
Here is a bit more chat and some pix and how 'healing' and 'training' are different
 
I’m now at 6 months from LTKR and nothing much changes. I’ve sold my MG as it really wasn’t doing it, or me, any good if just standing on the drive. My knee is still refusing to bend more than 60 degrees. I wasn’t experiencing much pain until recently, it just didn’t bend. However, i had a painful experience on the stairs on Monday when distracted I lead off with the wrong leg and exerted a lot of pressure on my tkr to bend. The pain was excruciating and took a while to get under control. It now doesn’t fell like it had been and is swollen so back on the ice and elevate. I has an appointment with the surgeon for 19 July but it appears he’s going off on holiday so it’s been rearranged for 16 August. I’ve applied for a disabled parking badge but probably won’t get one as the condition needs to be expected to Last more than 3 years and who knows how long this will last, I’d have liked to ask the surgeon before applying. The trouble is the parking spaces in uk car parks are very tight and I need my door completely open to manoeuvre myself onto the car. Working on doing something each week that are fun that I can do so went to the Superbikes at the weekend and paid extra for a track side car park to really reduce the walk . Had a brilliant time taking pictures of the races…. Onwards, staying positive
 
Oh my, Demelsa, that does sound disheartening, indeed.

Here in the US, someone with the issues you are having might consider getting another opinion, or find a specialized hands-on type of PT practitioner to see if they could help improve your ROM so you get more of your life back. I've been to an orthopedic massage therapist, trained in helping relieve tendon and muscle tightness, as my TKR leg has some restrictions in the hip and quad area from my past, pre-TKR movement restriction. But I don't know what sort of practitioners you may have available to you there. I suspect, if you want to do so, that there is a way to get some help to improve the situation, but not being there, I don't know what kind of helpful folks are practitioners in your area that could provide some help. Unfortunately, those folks aren't covered by health care insurance here, so I do have to pay out of pocket. But, if it means walking with ease and getting my full movement back, I figure it's worth it.

Maybe someone else from the UK will chime in, but I've certainly felt as disheartened as it sounds you are, but I was able to find people to see to help, so I'm hoping you find someone there to help you!
 
You are having knee replacement and they won't get you a disabled plaque? I am totally shocked to hear that. I had such a plaque for a couple of years even before the replacement as I absolutely was not able to walk for any length of time. Just got mine renewed last month - same month I had my second surgery. If they don't consider stage 4 arthritis and recovering from knee replacements sufficient grounds for a disabled plaque, then it is unclear to me what they would be considering at all...
 
My surgeon’s office told me I didn’t qualify for a parking thing. I guess it depends on the rules where you live.
 

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