TKR Assigned PT exercises and sharp pain – told to just work through it…….

[jds]

My arthroscopic debridement surgery was last Wednesday. It went really well, a piece of cake really, compared to the TKR procedure. It has completely resolved the catching, snapping sensation and associated pain when doing stairs. I still have some minor swelling but not too much now 4 days post-procedure. The post op pain was also very light. I was a bit unsteady on that side and weak but did not need a cane to get around the house. It's still a bit sore to walk on for any distance but getting around the house is no problem. When I start going up or down some stairs, my mind is still anticipating the snap and pain.......but it doesn't come. Hurray! I just hope the adhesions don't redevelop at some point.

 

[Lindylee]

That's great news, so glad it's helped. Don't overdo it though, Look after yourself.

 

[Helizabug]

Glad to hear it went well!

 

[jds]

Update after the arthro debridement: For the first 4-5 days after the procedure I felt that the debridement was a great success. The snapping feeling along the inner side of my knee was completely gone. Each day seemed like I made noticeable gains in pain free walking, stairs, etc. Then over the past week or so I'm now getting more sore and stiff every day. I still don't have any snapping but the pain has shifted to the outer side of my knee. It feels like my knee cap isn't tracking correctly. Sometimes it briefly locks up my knee until I reverse the movement (at least it feels locked up because of the sudden sharp pain). I'm also very tender on both sides, concentrated low near the top of the tibia. I'm in worse shape now than iI was before the debridement. I had a 2 week followup appointment with the OS scheduled for this coming Thursday but have moved it up to tomorrow. I'm not particularly swollen and the arthro incisions are healing up nicely.

I'm reading the e-book Knee Arthrofibrosis by Dr. Frank Noyes and Sue Westin (Noyes Knee Institute). They seem to paint a pretty grim outlook about waiting this long (15 weeks post TKR) to have the arthrofibrosis addressed. According to the book, my patella tendon may have permanently contracted (patella infera) which would require major surgery to correct. They contend that the fibrosis is caused by limited ROM in the early stages of recovery. I certainly had that early on but by around 5 weeks PO I could force extension to 0, and flexion to around 130 degrees. I was at 0 and 140 without force or pain (heel slides) before the debridement. Noyes and Weston are concerned about possible arthrofibrosis developing if a patient can not obtain 0 and 90 degrees by day 7 PO. The Noyes Knee Institute seems to embrace the use it or lose it mantra.

So a question is: What is the balance between the advice of rest and heal first and the ROM will come later; and the need to have good ROM early to reduce the chances of developing arthrofibrosis. The two concepts are in opposite directions.

I'll post an update after my appointment tomorrow with my OS.

Jeff

 

[Helizabug]

The conflicting information is really annoying, right?

It’s hard to know what to listen to as a consumer. Common sense doesn’t help because, to me, it all sounds like common sense. Data seems to be hard to come by because, maybe, it’s hard to build reliable studies about PT, patients’ perceived outcomes versus biomechanical outcomes, patients’ perceived compliance and effort, and so on.

I adhere to BoneSmart’s approach because I can stick with it. It makes more sense to me to let the soft tissue heal, fight the swelling, and engage in activity that I can sustain. Mine has not been the smoothest recovery, but I’ve been happy, enough, with it.

 

[Jockette]

Noyes and Weston are concerned about possible arthrofibrosis developing if a patient can not obtain 0 and 90 degrees by day 7 PO

The operative word here is possible, not will develop...

Very few of us had 90 degrees at 7 days and yet we did not develop arthrofibrosis and went on to have an excellent recovery.

There are all kinds of opinions about this recovery. I found the controversy shocking! I finally came to the conclusion that we just have to do what we think is best for our own situation.

 

[Celle]

There are lots of different opinion about arthrofibrosis. BoneSmart's advice - and what we have observed from the thousands of people who have been members - is that arthrofibrosis does not develop early and you don't have to work hard to prevent it.

In fact, overworking a knee that is newly wounded from surgery keeps its soft tissues hot and inflamed. Hot tissues are drier than normal tissues and dry tissues tend to stick together more easily than normal tissues, thus making them more likely to develop arthrofibrosis.

The choice is yours. Read the book by all means, but also consider our advice and the experience of many of our members, who have opted for a gentle recovery and not developed arthrofibrosis.

 

[jds]

Sorry, I probably should have waited until after the appointment with my OS tomorrow before creating my previous post. I'm just freaking out a bit since lately I feel worse than before the arthrofibrosis debridement. After a few days of feeling great, now the pain and stiffness are getting a little worse every day, and I have been taking it easy too - lounging around the house with my leg up most of the time.

Searching for answers to something you don't understand sometimes leads to confusion. Arthrofibrosis after TKR is apparently not common so I'm struggling a bit wondering why I developed it, and will it be satisfactorily resolved. And also is it actually the fibrosis that's causing the new pains.

Jeff

 

[Jamie]

It's frustrating, I know, and most people never can pinpoint exactly why they developed arthrofibrosis. It's a problem with all knee surgeries, not just with joint replacements. I hope your meeting goes well with your surgeon. Although you might not get an answer to the "why" you have this problem, your surgeon should be able to offer some advice about the next steps for you to improve your pain and stiffness.

 

[Helizabug]

I think you posed an important question. Thanks for giving me a place to think about it.

 

[TimeBuster]

I don't know what search engines you're using but on Bing, I found tons of information on Arthrofibrosis after TKR.

Question, are you allergic to any metal?

I ask because I know a few bones smarties on here who had scar tissue buildup after a TKR later find out they were allergic to certain metals.

Just throwing this out there you never know.

 

[jds]

My surgeon said that my knee is still early in the recovery after the debridement procedure, just give it time to heel. And come back in 6 weeks for a follow-up appointment. I guess I was expecting too much too soon but those expectations were based on her pre-surgery advise that you will be driving in 2 days, no PT needed, etc, etc. She did say that although there was quite a bit of fibrous tissue removed in the debridement, everything about the implant looked good. She really didn't have a good answer for what is causing the occasional painful locking sensation when straightening my knee, although I replicated it for her during the visit. Just take it easy and it should improve. The only way I could take it any easier than I have been since the arthroscopy would to be confined to bed.

@TimeBuster - I don't have an allergy to any metal that I'm aware of, but it's something to keep in mind possibly down the road if complications continue. I'll cross that bridge if it comes.

So the good news is that my surgeon doesn't think that there is anything wrong and all I need is to rest and work on low impact exercises (heel slides, leg lifts, quad flexing). The bad news is I need to rest for another 6 weeks just to get back to where I was in my TKR recovery sometime in the past. Ugh!

 

[sistersinhim]

The bad news is I need to rest for another 6 weeks just to get back to where I was in my TKR recovery sometime in the past.

But, there is very good news there, too. You won't have that awful bone on bone pain anymore! That's when you really realize that you're so glad you got this surgery.