Bad experiences after TKR

[Nana55]

I am a newcomer and am just learning about posting etc. I am 8 weeks post op and with aggressive stretching I measured at 80 on Friday. I am going to the OS Monday. I feel like there is a string running through the middle of my knee and like something is caught preventing by leg from bending near my upper tendon and in the lateral part of my knee right in the bend. When the PT pushes, I feel like my knee will explode. I am still on pain meds- one at night and one 3xweek before therapy but I can't tell that they are helping. I've had two major surgeries at age 27 and 30 and took very little pain meds but I feel like I have lived on Percodan.

I had the femoral nerve block and I think they hit the nerve as they tried to get in the artery. I have felt like the middle of my foot in on the hospital bed and I kept asking while the block was in for the nurses to move my foot off the bed. My leg was numb for the first 3-4 days. I left the floor and went to rehab and stayed 4 more days for 8 total. When I left the hospital, I had 40 degree flexing and after 21 PT visits I only have 80. They only used the CMP machine on me 3/8 days for 1-2 hours and had it set 40-45-50. I feel that part of my problem is the extreme swelling with right TRK 2-3 inched each day bigger than left.

I am elevating, icing and now doing heat right before bending followed by ice/elevation afterwards.

Manipulation is what the OS is saying within the next week or so. I am a registered nurse (34 years worth) and I am very upset with the nursing care I got. I have had to dopplers to rule out clots and had to have a unit of blood with HGB 12.1 before surgery and 8.4 up to 9.5 with a unit and iron pills 2 x day.

Any glimmer of hope for me. I am really starting to get depressed. I had the surgery to be able to work more comfortably for 5-10 more years and right now I could qualify for disability that I don't want.

 

[Jamie]

Re: Burning pain in quads

First of all, Nana55, let me welcome you to our forum. I'm glad you found us!

It is quite common for people to feel frustration with the recovery process after a couple of months. It's a long recovery requiring lots of effort and (even if you were told that before surgery) it somehow doesn't really hit home until you are square in the middle of it all.

At 2 months it sounds to me like you need better pain management. Your medication schedule of one pill nightly and one before each PT 3 times a week is not much in the way of pain control this early in recovery. Many of us who had knee replacements were on prescription pain medication on a schedule of 1-2 pills every 4 hours for 4 months and sometimes more if it's needed. Your body MUST be pain free in order for you to do the proper PT to recovery. Does your PT have you doing exercises at home in between the 3x weekly visits? You should be doing some working of the joint several times a day on your own.

I am glad to hear you are seeing your OS on Monday. You need to talk to him about your concerns and the need for more aggresive pain management. If he determines you need a manipulation, don't fear it.....quite a few folks here have had them and go on to recovery nicely.

 

[Josephine]

Nana, I've moved your post into a thread of its own so it won't interfere with twoyearspost's discussion and replies.

I note you said "I had the femoral nerve block and I think they hit the nerve as they tried to get in the artery" - in fact, the nerve block does go into, or rather close to, the nerve and the intention was for your leg to be numb so you could get mobile and have early PT with no pain at all. It shouldn't go into the artery at all.

It sounds to me as is you have a bad case of adhesions and that an MUA is very much needed. Quite probably the excessive swelling was the causative factor in this - same thing happened to my sister in her first TKR. For the first few weeks her leg was swollen and rock hard. She couldn't even get to 80! But she's fine now, six years on, and has pretty good ROM despite now needing a THR in the same leg!

I agree with Jamie about the pain management. To only be having a pill before bed and before PT is dreadful! You should be having something like Percocet 4hrly with an NSAID 8 hrly. Anything less is just cruel!

Tell you what - if they do anything like that to me when I have my knee done there will be hell to pay!

 

[Nana55]

Thanks for the quick replies. My leg does have a couple of places that are very hard. I have been trying to do massage plus the PT does too.
I do PT 3 x week: 30 minutes in pool; 15 bike and 15 treadmill; cones and step ups. At home, I do 15-20 on bike on therapy days and have moved by seat up four times with the last increase today and 15 minutes 2 x day when I don't have therapy. Plus I do stretching, leg bends, foot pumps, leg rises about 8 different ones in all at home.

My surgeon said my knee was much worse than the MRI/xrays showed and that it was difficult to do with a lot of disruption in soft tissue and the compartments of the knee?? all needing lots of work. He said that he too was in a bit of pain from all the work he had to do. The OS has 20 years of knee experience and does about 150-200 per year. His success rate seemed good but I am discouraged.

Sounds like I need to start hitting the pain meds. I was on Celebrex before the surgery and after but haven't had it the last two weeks since I live in Kentucky and we have had a bit of weather problem and my MD has not gotten my med preauthorized again due to being out etc

I told my physician friend who works with me that after manipulation I will come home with the 12 hour oxycotine and use Percodan the 4 hour stuff for breakthrough because he will write for me. He is a great guy and was my personal MD before I hired him for Public Health.

This is sad that so many of our docs are afraid to prescribe because so many in our area are using and selling. My OS is very conservative and won't use the CMP at home plus he doesn't believe in pain management. I think he SHOULD try it and see what it is like to be in pain.

 

[Jamie]

It does seem that the surgeons sometimes are hesitant to prescribe enough pain medication to see a person through this very difficult recovery. When that occurs, sometimes it is best to see your family doctor. For some reason, they seem to have a much better understanding of what it means to really manage pain. And without that pain management, as you now know, it is so very difficult to progress successfully. Hang in there and keep after it. You will find LOTS of support here when you need it!!

 

[Simon]

Nan

I went to inpatient rehab and they put me on 12 hour MS Contin (hydromorphine) as I had an allergic reaction to oxycontin) and 4mg Dilaude (also morphine) and it worked great. Hope you get the same relief I did. My knees were also a mess and the right one instead of taking an 1½ hours took 4 hours and my doctor was also exhausted as they could not even flip the patella up as they normally do, they could barely move it out of the way. On top of that the tibia cracked because of a previous knee surgery. Like you all this extra work caused my whole knee and leg to swell like crazy as was also checked for DVT as it was so tight and swollen.

I was lucky as my OS had had a TKR so I had no trouble with pain control. Because of distance (he is 2½ hours away) my GP wrote my prescriptions and that worked.

Glad you have a friend to help out, otherwise your GP can help.

I think we need to read these surgeons the riot act when it comes to pain control as without it you will not have a good control.

Good luck

Simon

 

[Josephine]

Thanks for the quick replies. My leg does have a couple of places that are very hard. I have been trying to do massage plus the PT does too. I do PT 3 x week: 30 minutes in pool; 15 bike and 15 treadmill; cones and step ups. At home, I do 15-20 on bike on therapy days and have moved by seat up four times with the last increase today and 15 minutes 2 x day when I don't have therapy. Plus I do stretching, leg bends, foot pumps, leg rises about 8 different ones in all at home.

Much, much too aggressive at 8 weeks! I'd suggest you do nothing at home on therapy days and just the bike on non-therapy days. Drop the extra stretches and stuff while you're in this stage of acute inflammation. You must let that settle else you'll be in line for a chronic condition that won't settle at all. A sensible mix of exercise and rest is what's called for right now. You need to get the joint moving but at the same time, you have to let things heal.

My surgeon said my knee was much worse than the MRI/xrays showed and that it was difficult to do with a lot of disruption in soft tissue and the compartments of the knee?? all needing lots of work. He said that he too was in a bit of pain from all the work he had to do.

Poor chap! He has my sympathies (crocodile tears!) but then that's what he gets paid the big bucks for.

The OS has 20 years of knee experience and does about 150-200 per year. His success rate seemed good but I am discouraged.

150 a year is barely a hobby - averages about 4 a week if you work it out. Minimum for an 'expert' is 500 per year. Top notch is 1,500+ which is about 30 a week or 6 a day!
(avg: 5 day week/46 week year).

Sounds like I need to start hitting the pain meds.

My OS is very conservative and ...... doesn't believe in pain management. I think he SHOULD try it and see what it is like to be in pain.

Couldn't agree more, my dear!

 

[Nana55]

It's Nana with bad experiences again. First of all, I love the sight. This is the first time I have interacted on one of this as you can probably tell.

I have a history of excessive scar tissue so I can't figure out which thing is causing the limited motion of just 80 degrees of flexion with some limitation in extension, I think she said 5 but it needs to be at least 0?? the swelling or the scar tissue. I go to the OS tomorrow and he and the PT say that after Manipulation I MUST move more and be more aggressive. Mayo Clinic suggests the CMP machine everyday for two weeks and PT 5x week.

Josephine, you said you felt I was being too aggressive at eight weeks but with the flexion I have and reading about posts talk about 110 at less time out is just gets so discouraging.

Also, has anyone on here actually had a manipulation and how long were you back in the acute pain stage. I may be a nurse but it doesn't sound like fun and when I mentioned to the PT aide said Bless your heart! with a big facial grimace.

Thanks folks!!

 

[Jamie]

There are a number of forum members who have a manipulation. Do you know how to do a search of the various threads to find some of the posts? If not, I can guide you through it. As I recall, most people are back on track within a week or so. You are not awake when they do the manipulation, so you won't really be aware of what the doctor is doing.

 

[Jamie]

Nana55....here is some information from Josephine from an earlier thread that should make you feel better about having a manipulation.....


In a manipulation it's the scar tissue - or more properly, adhesions - that get broken up. The surgeon will only put your knee through a perfectly normal range of motions, just like you do in your PT - but he applies some pressure to the flexion to make it go back to a good angle. It's sounds an awful lot worse than it really is, so please don't fret on that score. You'll read some posts about the danger of fracture but believe me when I tell you that the surgeon has the skill and expertise to know how much is enough and how much is too much. I've seen hundreds of MUAs (manipulation under anaesthetic) done in my time and NEVER seen a fracture occurr. Not once!

Now, as for the aftermath, that varies a bit. Most people have some pain in the first 24hrs but nothing some pain meds and icing can't handle. Nothing near as bad as the TKR itself. A very few have pain a day or two longer but not many. After that, it's back to the PT to make the most of your new 'freedom'! Often before you even leave hospital. One or two have been sent home with a CPM (continuous passive motion) machine to use.

As for why the need for a manipulation happens, I have explained that elsewhere but since you are new to the forum, I'll explain it again ...

All the structures in the body, muscles, tendons, ligaments, even gut and lungs, need to be able to glide over one another smoothly to let our bodies work. To do this, the body produces a special viscous fluid that acts like the oil in your car engine and lubricates everything with great efficiency.

Now when the surgeon opens up any part of our body, the internal stuff gets exposed to the air which is, by comparison to the body, cool and dry. The natural reaction is that the fluids evaporate and the tissues cool. This can make the organs and structures dry so when the wound is closed, part of the healing process is for the body to go into overdrive, producing extra fluid to replace what is lost. This is one reason why you need IV fluids during and after an operation.

Now as a general rule, 95% of people manage to make up this fluid loss and normality is restored quite quickly. But in the other 5%, for a variety of reasons some known, a lot unknown, their bodies are deficient in making up this loss and lacking the necessary lubrication, the ligaments and muscles lose their 'glide-ability' and beging to stick to one another. This is called adhesions. If this happens and the function of the joint is affected, the answer is to work the joint with some force, thereby freeing the structures from their locked-in state. Much as you would if you got a sticky or rusty lock and put some oil in it, you'd work it back and forth to free it up. That's all a manipulation is.

Don't be fearful (if you can!) but look forward to a new oppotunity to get your function and ROM back in full again.

 

[Josephine]

I have a history of excessive scar tissue so I can't figure out which thing is causing the limited motion of just 80 degrees of flexion with some limitation in extension, I think she said 5 but it needs to be at least 0?? the swelling or the scar tissue.

Yes, at least 0, maybe even -5 or 10. And it's most likely the swelling and the scar tissue or adhesions.

I go to the OS tomorrow and he and the PT say that after Manipulation I MUST move more and be more aggressive. Mayo Clinic suggests the CMP machine everyday for two weeks and PT 5x week.

Josephine, you said you felt I was being too aggressive at eight weeks but with the flexion I have and reading about posts talk about 110 at less time out is just gets so discouraging.

Well yes, this is true - you do need to be more aggressive but there are degrees and I truly feel that with the amount of swelling you have, the PT shold help you be more selective about what you are doing. Quality more than quantity, you know? A CPM sounds like a good idea. But don't fall into the trap of comparing your progress to other people's. Everyone's journey is different.

Also, has anyone on here actually had a manipulation and how long were you back in the acute pain stage. I may be a nurse but it doesn't sound like fun and when I mentioned to the PT aide said Bless your heart! with a big facial grimace.

Thanks folks!!

Oh dear! We do have to watch our grimaces, don't we!? Well, Jamie already said what I would say so no point in repeating it.

 

[Nana55]

Hi Folks,
It's official, after the OS visit I am scheduled for the manipulation Wednesday so if you are praying folks say a prayer. It was discouraging to hear even though I felt sure it was coming. Thanks for all your help, Josephine, Jamie, Simon et al and if you have anymore works of wisdom I appreciate them.

 

[Jamie]

I don't know about "words of wisdom," but I'll be praying for you and in no time at all you'll be back on the road to recovery. This is just one of the things that happens sometimes and you were so wise to get it taken care of quickly. If you've read posts from those who had this procedure, you'll see that it almost always results in a quick improvement.

 

[Doug]

Just a word of the light at the end of the tunnel...It seems that for me at around 7-8 months post up the swelling was gone and the flexion really turned loose. It takes time and effort folks.
And I'll throw a prayer out for ya too.

 

[calling_all_angels]

Nana,
Here is a little rope to hang on to ______. And I always say if things get tough and you need a pray or 2 just tug on it and I will feel the tug and start praying extra hard for you.
And just having the rope makes you feel not so alone.
^i^

 

[Buckeye]

Nana,
Sending prayers and hugs your way!

 

[Nana55]

Hello Everyone,
I had the manipulation on Wednesday went in 0/75 and OS said he got me to 0/130 post op. Sent me home with CPM and daily PT for next two weeks. The therapist got me to 90 today with much screaming on my part.

I am trying to maintain a positive attitude but I think I am experiencing some depression. I want to cry alot and I have had several pity parties but not many people are coming to those.

For anyone who had the manipulation, did you continue to experience pain like this when you went to PT?

Thanks and HAPPY VALENTINES DAY TOMORROW!!!

 

[calling_all_angels]

HAPPY VALENTINES DAY to you Nana!!!
I am afraid that I thought that it would be easier to get ROM after a manipulation, goes to show you how much I know. When I fell years ago after knee scope surgery I slipped on icie steps at Church did a really deep knee bend and poped loose the scar tissue and after comming home and icing it for a hour it was like a mircle!!!!! The knee moved just like it should. So I guess I thought that a manipulation by a Doctor was the same except you get to be out like a light while they do the cha-cha with your knee.
I can understand why you are feeling depressed. It is hard to think that we can not snap back into our lifes as fast as we want. I will keep praying that the next PT in like butter.
^i^

 

[Nana55]

Calling All Angels.
You are such a great spirit. I am actually moving some better after two days of PT. She got me to 90 on Friday with still quite a bit of pain in the stretch. I am on the CPM about 4 to 5 hours each day at home and cranking the stationary bike.
Curious, did others have such intense pain during the stretches in PT? or is that a DUMB question? I feel like such a big baby at therapy. The girls have been so good to me that yesterday I bought them some chocolate covered strawberries.

I continue to find good information on this site each time I visit.
Thanks

 

[Josephine]

Nobody on here is a big baby - nor even a small one! My hat's off to everyone that decided to go through with this - and that includes me!