TKR Brownie's Good, Bad, & Uglies

[Josephine]

She said without forcing it I can end up with an MUA!

Well, you know what I am going to say about that!

My PT says he does glue, but it looks like dissolvable sutures to me

He probably uses both. Glue is used on the skin but conventional sutures are still required to close the wound inside.

That incision is where the antennae for the computer navigation system was placed on or in the tibia. I don't know if a hole was drilled into the tibia for that. Anyone know?

Interesting point. My experience with other similar devices has been that the guide is a pointed tool which is just speared into the surface of the bone. I'll ask MAKO and find out.

Started researching this issue and coming up with myositis ossificans

Oh Brownie! You of all people should know not to go Googling in that way! Myositis indeed! I very much doubt it!

I suppose the infection is involved or maybe the pain is from the infection OR the pain could be from me being up for so long going to dr, pharmacy etc.

Or all of the above? Of course, at two weeks out it couldn't just be plain ol' post op pain, don't you think?

So how are you doing on my famous 5 questions?
1. what medications have you been prescribed, how much are you taking (in mg please) and how often?
2. how often are you icing your knee and for how long?
3. how high are you elevating your leg, how often and for how long?
4. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and
5. what kind of PT are you doing? How much and how often?

 

[Brownie51]

Okay well now I admit I am worrying more. The stabbing pain in ankle/lower tibia is keeping me from walking, have to use walker now and try to keep all weight off my left foot. The wound is not healing much. It has to fill in, it's ugly and red margins. Very tender on one side. NO pain when I am NOT bearing weight on that leg.
Now I am worrying that they left a part behind! A little piece of the marker that gets pressed into the bone?
Also I looked back at photos and when the dressing was first removed from that separate lower incision, I can see tiny bubbles, blistery looking specks around the the suture punctures. I can only see this when I greatly enlarge it. otherwise didn't notice. But once I realized it I went back and examined photos and can see that it was a suture allergy, the tissue kind of turned to mush. Half of it is open in a diamond shape and then one end is like a keyhole. The incision was originally 1 inch long. And always had a small open spot in the middle which is now the diamond.
OH NO the 5 famous questions!
Still taking pain med on a schedule. Oxycontin 10 or 20mg BID. I take the 20mg at night. Then Percocet 5mg/325 1 or 2 every 4 hours. Sometimes I can go 6 hours. I take Celebrex 200mg daily. I am still on my anticoag shots, Arextra.
I use the ice off and on much of the day but in the last couple days not the constant ice like I did at first. My swelling has really come down! I ice after > activity and now I'd say I am icing about 5 or 6 times a day for 30 minutes. If I am not up, then I have my leg elevated in my bed (electric). I have my pillow system set up so knee is not bent, venous flow ok. I can't believe how quickly the swelling is dissipating.
I do my exercises all day long instead of going at it all at exact intervals.. I am getting on the recumbent bike now for just a few minutes, around 10. Dr. said 4 times a day when I saw him Friday but this infection thing has slowed me down and I haven't been as active. Walking even with walker or crutches is excruciating from the ankle pain. My knee is handled by my pain meds really well.
My flex is 90 and 0 but I can actually get it to more than 90 once I am warmed up and especially when on the bike.
So still never got my OS, will call first thing in the morning. I hope he will do an xray to check my lower tibia for problems. A tiny fracture or something left behind? I decided the myositis wouldn't hurt this bad.
Thank you Josephine!
I so pleased with my actual KNEE! It was over a month before I felt this good with the last knee! But I guess it was too good to be true. I just hope hope hope this infection thing is going to lead to a bone infection. My worst fear.
Thank you all for listening.

 

[Josephine]

A little piece of the marker that gets pressed into the bone?

Now don't go into overdrive! The instrument concerned would be too solid and strong to even leave debris behind! Bit like a sharp bradawl

I can see that it was a suture allergy, the tissue kind of turned to mush.

As for the suture, it won't be an allergy though superficial dissolvable sutures do sometimes cause problems normally a small stitch abcess. Do you mean by 'turned to mush' that the tissues are gungy and infected looking? That's normal in the circumstances and will resolve.

Half of it is open in a diamond shape and then one end is like a keyhole.

Yes, it will be but open is good. It lets the wound drain and that helps healing.

Sometimes I can go 6 hours.

And yet you say

I feel the pain on the front of my tibia when I am up, more intense than my post op knee pain. Now there is a small amount of ankle tibial pain when reclining

so why aren't you being more diligent with your pain meds?

I do my exercises all day long instead of going at it all at exact intervals.. I am getting on the recumbent bike now for just a few minutes, around 10.

You're only 2 weeks out. I think your doctor is asking too much of you for this stage. For another couple of weeks by all means do them 4 times a day but only for 5-10 mins max. You know the saying "less is more"! Too much exercising causes swelling which includes internal swelling. Just as deadly.

I think you need a refresher on the following:
The importance of managing pain after a TKR and the pain chart
Myth busting: no pain, no gain
Swollen and stiff knee: what causes it?
Activity progression for TKRs
Myth busting: the "window of opportunity" in TKR
TKR: work “smarter” and not “harder”

 

[Brownie51]

Thank you Josephine. Oh I would love it if this is caused by doing too much and the infected wound is just coincidental! I gave up my walker a couple days after I got home. The distal tibial pain just started on Saturday at noon. I had not had it until then. And it was right after all that activity with dr and pharmacy (no walker or cane etc). So lets hope! Until today the distal tibial pain was only while weight bearing but now it keeps hurting even after I've sat or laid back down (grammar). So I was only medicating my knee pain but now I am taking my Percocet, 2 every 4 hours, that's the maximum dose he ordered. The Percocet doesn't help the stabbing tibial pain at all though.
Oh Josephine, there were tiny blisters around the sutures when I went back and enlarged the photo and it had gotten gradually more reddened as days passed. They were huge black sutures on top of the skin with long tails that hadn't been cut. I kidded Dr. that he had given me Daisy Duck eye lashes on that incision. Where the suture went into the edge the skin just went to mush gook.
So to recap you think I have 1. infected wound 2. painful tibia from putting too much weight on my leg too soon, too often?
This is the first time I have felt emotional since my surgery. I didn't sleep much last night. As a matter of fact I was playing Words with friends the entire night with one of our UK bonesmarties. I feel pretty discouraged right now and am hanging on to my emotions by a little skinny thread! :rolleyes:
I am going to see Dr. Reff at 3:45 PM and my best friend is taking me. She always calms me down. She thought I might be smart to pack a bag for the hospital just in case. To tell you the truth I am not going to fight it if Dr. Reff did want to give IV antibiotics for a day or two.
Okay as usual I have rambled on. thanks for being here!

 

[Josephine]

How about posting the picture for me?

 

[Brownie51]

Also, my TKR regular incision has dissolving under the skin sutures and seems to be okay. I don't know why but on Friday the office manager sort of cleaned up the wound, and then applied steri strips practically on top of each other. I would have liked to see some space in-between so I can monitor the incision. She did the same thing on the distal tibial incision so that when there was drainage it was all trapped underneath the strips.
Also Dr used the Zimmer tools/products for my surgery. Could a tiny antennae still be left in my bone causing all of this?

 

[Nanners]

Hey Brownie, did not realize you were on to tkr #2. Congrats! My best friend had something similar pop up on her knee (blister like). Come to find out it was a allergic reaction on her knee. I believe they found out that the Percoset 5/325 was the culprit in her case. Hugs!

 

[Brownie51]

Well I saw my Dr, took xrays and Dr. says my new pain is caused by the notches he made in my distal tibia. They are easy to see on the xray. There are no fractures. He wants me to keep the incision clean and dry and covered. He said it was not a suture allergy, he says they are nylon sutures in that incision and that no one is allergic to them! He said it is all traumatic and that the tissues are just traumatized and that's why these little glitches pop up. I agree! No one should be digging grooves in our bones so no wonder it smarts.
His answer machine gives the wrong message, tells you to leave your name and number and it should tell you to enter your phone number on your keypad. He is looking into that!
He is having me come back on Wednesday. That makes me feel good that he is taking the time to see me again, and keep an eye on my incision.
Unfortunately I still can't walk. Am managing better using crutches. I guess this is one those things where only time is going to solve the problem!

 

[Nanners]

Just sending you some hugs! Feel better!

 

[Brownie51]

Distal tibial pain is even worse today. It is over my pain scale (#12?), stabbing sharp pain when weight bearing, even when barely tapping left foot on the floor. I am using a rolling office chair to get around in the house. I am completely non weight bearing now due to the pain. Once it gets started now it is difficult to stop it. The tibial stab wound looks like it is granulating in and the redness has not increased.
I hope this resolves soon. I have gotten so discouraged by this. My knee is fine. I am able to sit down in a chair with feet on the floor, at 90 degree angle without even thinking about it!

 

[Nanners]

Aww hugs! I hope your pain eases soon. Poor love! Hugs, hugs, and more hugs!

 

[Brownie51]

Woke up with pain in my right knee which haven't had in weeks. Using only right leg these few days is probably too much stress. The pain in my tibia is so severe, really losing it here. Have an office chair I am using as wheel chair, just stepping down lightly with left leg is excruciating.
I am convinced I have a stress fracture caused by the notches placed in my distal tibia for the navigation device. I read that the first xray often will not show the fracture. In 2 weeks it will show up or if you need immediate diagnosis you get an MRI. So I want an MRI.
I stopped the Oxycontin last night so it's been 24 hours since I have had it. It makes me sweaty and nauseated, I think that's what is doing it. But the Percocet 5mg 2 tabs is not enough for this pain. I am so disheartened. First I have to get a diagnosis on this new tibial pain from Dr. Reff, then what? I read they do an air cast and non weight bearing for 4 weeks. I can't imagine this. If my incision was closed up I could get in the pool.
Josephine and anyone can you help me? I am 99% positive about my new diagnosis! What now? And about my pain med...I am on Percocet 5mg 1 or 2 every 4 hours. I would rather go to the Norco I had with my other knee replacement.
How does Percocet (oxycodone) 5mg compare to Norco (hydrocodone) 10mg? I tried a dose twice now of the Norco and I felt ok. I think maybe the oxy's aren't for me, plus refills are so much easier with Norco since it is not a triplicate. Anyone?
I see Dr at 2:30. Thank god I have such a wonderful friend who is taking me to all these appointments. I am so lucky. I am using my office chair right out of bed to get to the bathroom and kitchen. Can't manage to do the step down into living room.
Hope my fellow June bugs are doing okay.

 

[bottomshollow]

Brownie51, that you are problems and are in such pain. Hope you can get this resolved very soon. Sending healing prayers your way.

Please take care of yourself and keep us updated. We really do care.

 

[Josephine]

I am convinced I have a stress fracture caused by the notches placed in my distal tibia for the navigation device. I read that the first xray often will not show the fracture.

You know, I think you could well be right! You have the xrays? Can you post them for me?

I read they do an air cast and non weight bearing for 4 weeks. I can't imagine this.

You read this where? The same site you got the 'myositis' from?

 

[Titianlady]

Oh, my gosh Brownie51 Marianne, I am sooo sorry this is happening to you! When do you see the Dr for that MRI? You certainly can't go on like this. You need a deffinative diagnosis and course of treatment.

I found that OxyCodone 20 mg tabs worked wonders for me, while Percocet 10/325 made me feel slightly nauseous. Maybe it was the Tylenol in the Percocet. Norco was not strong enough.( hydrocodone).

I feel terrible that you are in pain and not really knowing why..please know I'm thinking of you Marianne.. Xxx

 

[Toothfairy]

Poor you, I am glad to hear your knee feels good but this lower leg pain sounds really miserable.
I hope you can get an explanation for and a solution to your pain soon.
Hugs Toothfairy x

 

[Brownie51]

MY xrays don't show a stress fracture but it doesnt show up for a couple weeks. Josephine I read my stuff on pubmed so thats how I came up with my diagnosis. Saw the doc and he's not convinced that its the problem but has not suggestiongs about why I have such pain on weightbearing in distal tibia.
So he puts me in a boot and tells me not to take it off, not for shower, or anything. And to cut my pants to get them off over it. REally?? I still have a wound that needs twice daily care! I talked to him about the Percocet not holding me and wanting to swtich pain meds and that I am off the Oxycontin because it makes me feel sweaty and nauseated. So what does he do? He leaves me on Percocet 5 mg. The new Rx is Percocet 5 mg one tab every 4 hours #30. I have been taking 2 every 4 hours and it wasn't holding me (since the pain started Saturday). So he is weaning me off pain meds at 2 weeks post op even though I have painful complication.
So I am taking one every 4 hours on the clock but there is no way in hell I can do my exercises without more pain med especially not while wearing this giant boot. They gave me a size medium which is 4 inches beyond my toes so managing this on crutches is really fun. They didn't think they had a small but found one after they'd put this one on me but he said it's fine.
I really think he is annoyed at me for diagnosing myself with a complication of his surgery. Maybe I am wrong but then he sure didn't figure out the reason for my pain and tenderness.
So I get a nuclear bone scan on Tuesday then see him again on Wednesday. I wish I had never brought up the pain meds. Here I was not being helped enough with 2 percocets and now I have to rely on ONE! I don't want to go back on the Oxycontin I have left but I might if I can't stand the pain. He said it wasn't a good time to change pain medication so that is okay but why he cut it back to one I don't know.
NOT HAPPY. So tired of it all.
I hope everyone has a good 4th!

 

[Nanners]

The percoset with Tylenol tore up my stomach! Sounds like he replaced your percoset w/Tylenol, to the Percoset only pill. Maybe it was a mistake on the amount, I would call his office back and advise that the med is not enough. Hugs!

 

[Josephine]

Marianne, I have an eye for occult fractures. Spotted a lot in my day that were missed by senior orthopods!
Post the xrays anyway.

 

[Brownie51]

Josephine I am trying. Can I email them to you? I am having trouble attaching becuase I have an android phone and mac computer and can't get them into the right place to pull up.