Revision TKR ArtGirl needs help with recovery woes

ArtGirl

new member
Joined
Jan 11, 2018
Messages
10
Age
43
Country
United States United States
Gender
Female
Left knee reconstruction utilizing cadaver ligament, Aug 1987
Post-op PT disaster from Aug 1987 that resulted in revision left knee reconstruction, June 1988
Left knee hardware removal, Aug 2007
Left knee arthroscopy and meniscectomy, 20013
Left knee arthroscopy, Oct 2015
Left knee total joint replacement with MCL release plus "pie-crusting" on (lateral retinaculum?), Nov 27th 2017
Right knee TBD 2018

45 days post-op. Been in full knee brace since surgery and will wear it another 2 weeks min. I don't know my numbers regarding flexion and extension but I can bend it about 90 degrees and cannot straighten it out all the way (I go to PT tomorrow and will find out). I'm taking Tramadol 325 for pain and it doesn't help at all. Still have a lot of swelling along with a suspicious red "sunburn" on the outside of patella that won't go away (with nightly low-grade fever 99.2-99.8).

I'm going out of my mind with pain, depression and disappointment. I prepared for this TKR with 2 months of pre-op PT. I hear/read other people's experiences and feel bewildered about why I seem to have such minor improvement. I don't know what's normal or if I should worry. I'm here because I'm upset and need the company of others who know what I'm going through. I'm 47 and know my right knee will eventually need a TKR, too.

Has anyone else in this November 2017 had complications like this? Is my progress (or lack thereof) normal? Should I get a second opinion to find out if something's wrong?
 
winter welcome 2.jpg
@ArtGirl, so pleased that you have joined us here on the forum. As you can see, I have moved your post from the November Nimbles' 2017 Recovery Club thread into a thread of your own. Here you and your questions and concerns will receive the attention they deserve.

I am giving you links to the essential articles on TKR recovery from our Library:
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
5. Here is a week-by-week guide for Activity progression for TKRs

The Recovery articles:


There are also some cautionary articles here

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.


Please don't be overwhelmed by the list. The articles are not lengthy and contain information that will answer many questions and help you make your recovery much easier on your knee and on you.

We are here to help in any way we can: answering questions and concerns; supporting and encouraging you from start to finish; giving you a place to vent, whine, complain if you need to; sharing experiences with one another; and having fun and some laughs along the way.

Take care and keep us posted. We care.

(I have added you to the November Nimbles' 2017 Recovery Club.)

 
Hi, @ArtGirl, and welcome to the community. Our members have all had TKR and know what you are going through. Your progress on flexion and extension is completely normal. You don’t need to push for better numbers because those will come all on their own as the swelling in your knee goes down. In your early stage of recovery, it’s also completely normal to be exhausted, in some pain, stressed (though we will do our best to help you lose that stress), and emotional. TKR is a major surgery that knocks us all on our butts!

I’ll tag someone more medically knowledgeable to address your fever and other symptoms. @Celle should be by soon.

Do read all the articles bottomshollow left for you. They’re short and offer excellent advice for how to handle your pain and physical therapy. Keeping physical therapy gentle is a big factor in reducing your pain and also in the healing of your knee. Knees that are pushed too hard in recovery don’t recover faster. Aggressive PT can set recovery back a few steps.

This is the place to ask any questions you might have. You can also tell us of your triumphs and concerns, and vent to your heart’s content. We’ve been in your shoes and want to help. :friends:
 
{{{{{HUGS}}}}} to you @ArtGirl! You are not alone! There are many people here on Bonesmart who have gone through similar recovery as yours, and many who are quite knowledgeable about the recovery process. You are in a good place here, welcome!

I am so sorry you are experiencing such difficulties. The frustration and "why did I do this??" thinking has hit all of us at some point. At 45 days you are still in the very early stages of healing; it's hard to believe it right now but you WILL get better, you just need time and patience. We are all rooting for you!

Please read through the links that bottomshallow posted above, they may help ease your mind. Take care and know we are here for you. :friends:
 
Welcome to Bonesmart! We are here for you and will help you the best we can. Your knee is still a baby and you need to spend a lot of time icing and elevating. As long as you're swollen, you will have tightness and lower ROM. Your only job should be getting that swelling down. Over exercising will increase that swelling, so take it very easy.
 
Hello @ArtGirl - and :welome:

I'm sorry you're still having such a lot of pain.

Your poor knee really has been through the mill, with so many operations. Because it's had so much surgery, it may take a bit longer than most to recover.

That low-grade fever is probably nothing to worry about, but it would be a good idea to let your surgeon know about it.

Have you been icing your nee - that helps to reduce pain a lot. There's an article about icing in the reading list that bottomshollow left you.

Don't worry about your Range of Motion (ROM) yet. Your knee needs to heal first and the ROM will come as the swelling goes down.
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

Don't feel that you have to exercise your knee a lot - just a little bit of walking around the house is enough right now. It's not exercising that gets you your ROM - it's time. Time to recover, time for swelling and pain to settle, and time to heal. Your ROM is there right from the start, just waiting for all that to happen, so it can show itself.

As for pain relief, Tramadol 325 (also known as Ultracet) contains a small dose of Tramadol (37.5 mg) and Tylenol (325 mg). It may be that you still need larger doses, for pain relief to be effective. If your surgeon or PCP will prescribe Tramadol and Tylenol separately, you can safely take them in combination, as shown in these charts - the first one is for 4-hourly doses and the second one for 6-hourly.

aa-tramadol-routine-2-jpg.51125

The safe daily total for Tramadol is 400 mg and for Tylenol it's 4,000 mg. You do need to check that there is no Tylenol (Acetaminophen) in any of the other drugs you're taking. If there is, allow for that by reducing one of you other Tylenol doses, so you stay within the safe daily total of 4,000 mg.

Once your pain is under better control, you may be able to reduce the doses again.

I hope this helps and I look forward to hearing how you're getting on.
 
I'm so glad I found this site and all the wonderful folks on it who've been through no-so-easy TKRs. I deeply appreciate the informative, supportive and helpful info from everyone. I really do feel better (emotionally) and will not focus so much on ROM as the definitive indicator of progress or success. (BTW, on Day 1 PT my ROM was 73 flexion and -22 extension, and 5 weeks later it was 110 flexion and -11 extension). It still clicks during both flexion and extension and seems to have random patellar tracking issues, but my hope is that these issues go away as the swelling goes down. I'll see the doc on Thursday and will provide an update then. Thanks again to everyone who kindly offered advice and support! :angel:
 
That clicking drove me nuts for a while after my TKR. It has gradually started to resolve itself as I heal more. The doc warned me about it so I wasn't totally surprised when it started up after the worst of my swelling had gone away. It should subside after a few weeks.
 
BTW, on Day 1 PT my ROM was 73 flexion and -22 extension, and 5 weeks later it was 110 flexion and -11 extension
That's a pretty standard progress. But the thing is, if you continue with the PT, it's likely your swelling will increase and that ROM will decrease. You need to read this article too Swollen and stiff knee: what causes it?



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?
 
I had my left knee replacement last July and the right knee last week. I ran a low fever just under 100 mainly at night for 2-3 weeks with first one and I’m doing the same this time. I wasn’t nearly as worried this time, I knew it was normal. My OS said as long as it’s under 101 it’s okay. Six months out on lefty and it still clicks, I wish it didn’t but if that’s the only problem, I’ll take it. We’re all here for you and understand your problems.
 
Your ROM progression is fine for where you are in recovery. Extension can take longer to regain than flexion, so continue to be patient. Like you said, don’t sweat the ROM. It really does take care of itself, if you take care of yourself and treat your knee to daily activities and other normal movements.

My knees currently don’t click, but they each clicked between two and four months of recovery. First one would click, then the other. They almost never clicked in unison, alas. I would have recorded that. But the clicking is something most of us get to enjoy at some point.
 
My new knee still clunks. I can hear it and feel it, but it doesn't hurt. I think it's just something that some knees do.
 
Just wanted to share an update about my recovery since my Nov 27, 2017 TKR: After 7+ months of excruciating pain, continued knee instability, chronic swelling, tendon impingement (not to mention the constant crunching, grinding and searing pain), and being forced to wear a custom-made brace just to stand up, my surgeon FINALLY gave up and referred me to an Ortho Specialist in Philly. Verdict = THREE failures: 1) Surgeon failed to properly align/place device; 2) Surgeon improperly used "pie-crusting" technique during TKR which caused patellar instability that resulted in 3) device failure.
What makes me angry is that I contacted FIVE doctors over the last 3 months asking for help only to be told that my X-rays looked fine and that I had to wait 6 months for my leg to heal before any doctor would see me--in spite of the fact that anyone with eyes can see my knee is 2x larger than it's twin and is obviously misaligned! It was no comfort to hear the Specialist say that anyone who looked ONLY at (my) X-rays would reasonably conclude nothing was wrong because my implant had failed and needed to be replaced as soon as possible. I cried when I heard him say those words because I knew ALL ALONG that something was terribly wrong but NO ONE would do anything to help me. And this doc HEARD ME.
So I went to Philly yesterday for all the Pre-Op testing and am cleared for Revision surgery at the end of the month. This time around I'm having my mom and daughter stay with me to avoid the healthcare facility problems I experienced last time (pain schedule and dose snafus, leaked ice packs=wet bed in the middle of the night, to name a few). And I won't go to a SNF because I won't be home alone.
The pain is a constant 7-8 even with Tramadol, so I'm basically hanging on to my sanity until this broken device is removed from my body. To that end, I'm now seeing a therapist who specializes in chronic illnesses and disability-related issues. And I have my former surgeon to thank for all this. All I can do now is hope and pray that this next surgery will provide results that I can live with.
 
I’m in the philly area. Can you share what doc was responsible for your failure and who is doing your revision?
 
Hello again @ArtGirl
I'm sorry to hear that you've had so much trouble and I am really glad you've finally found a surgeon who has listened to you and is prepared to help you.

Congratulations for being persistent and keeping on trying to find a surgeon who will do something for you.
At the same time, I'm sorry to hear you are going to need a revision - but your new surgeon sounds as if he is going to give you a much better result.

Do you have a date for your revision surgery? If you can tell us that, I'll add it to your signature.

I had a revision 6 years ago and my recovery was very much like my original recovery. With your knee fixed properly, there's every chance that your recovery will be easier than last time.
 
I'm not comfortable naming the Orthopod who performed my original surgery other than to say he practices here in Wilkes Barre out of WB General Hospital. The only good thing he did for me was to refer me to The Rothman Institute to see Dr Nazarian, who told me several things he probably shouldn't have about what had been done improperly to my knee. If Dr Naz had accepted my health insurance, I would have asked him to fix my knee. So Dr Naz gave me some names and Dr Neal Sheth was one of them. I like Dr Sheth because I ask a TON of questions and am a difficult patient, but he stayed personable, patient and respectful throughout our visit and answered every tough question I threw his way. I'm confident in his abilities and his expertise. Hope that helps...
 
The Revision date is July 31, 2018
 
Thank you. :flwrysmile:
I've added your revision date to your signature.
 
So sorry to hear your results....I hope that your revision goes to plan wishing you all the best
 
My surgeon is also with Rothman Institute. They have an excellent reputation. I’m glad Dr. Nazarian was able to identify your knee’s problems and refer you to an excellent surgeon for your revision.

Most people who undergo revisions have very good results, comparable to a primary TKR. Your recovery this time around should be more... well, not fun, because there’s not much fun about this recovery, but normal. Wishing you the very best!
 

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