Knee Infection* CABLAND's 11/13/2023 LTKR Recovery

[CatieViv]

We have a lot of snow too. It was difficult to clean my car off yesterday. And walking in the stuff with the cane isn't easy. I hope your rest day was a good reset. You might want to take another soon!

 

[cabland]

Fortunately, I don't have to live with the long term effects of the snow...Texas! It really was a snow "day" this time around.
On the downside, my rest day didn't seem to do the trick. Indeed, Monday and Tuesday were pretty miserable. I went to PT on Wednesday and brought up my primary concern - pain with movement going into full extension and from full extension (as in every step I take). She changed up my exercises and stretches a bit to try to better address and improve patellar tracking which she thinks is part of the issue. We'll see if it works! I also see my surgeon next week, but don't expect any additional insight there. I may ramp the pain meds back up a bit (although drop to hydrocodone from oxycodone). Good times!

 

[cabland]

Update - I'm 10 1/2 weeks out from my LTKR on 11/13/2023. Saw my surgeon yesterday and told him about the continued pain on the left side of the knee. He took xrays which, of course, looked fine to him (don't they always). When I view them, I can't quite tell if there is some slight overlap to the lateral side of the knee (perhaps contributing to the "catching" sensation) - not sure though. Having said that, and this may be my imagination, I THINK it may be getting a little better.

In the end, he prescribed 4 more weeks of PT, and put me on a short term dose of steroids. This time, I am reducing the PT to twice a week (instead of 3X) to give me a bit more recovery time between sessions - taking a queue from @mendogal (although I know you reduced to 1X). Along those line, my last session was yesterday, and my next (due to scheduling conflicts) isn't until next Wednesday so I'll get a full 5 days off! I am resting today and plan to focus mostly on walking (modest amounts) in that window.

Sooo...instead of getting a better feeling for where I am at at the 3 month mark (mid February) it will likely be late February or early March now. We'll see!

On a related front, my other knee which, if you've read the beginning of this thread, you may remember was supposed to have been done at the same time but got caught up in insurance issues, is starting to bug me more now too (hard to "PT" just one knee) - as expected. I asked my wife to watch how I was walking...she had to ask "which one is the bad one?" (because they were both so stiff!).

 

[mendogal]

I just want to reassure you that even three months is early in this year long recovery.

Sometimes a specific pain, lump, or stiffness will somehow sort itself out with "tincture of time" as our new knee and our bodies adjust to each other.

Glad your PT is flexible in her approach based on your evolving needs. That's always a plus. Hang in there and keep us posted!

 

[MSuki]

I hope you’re right about the improvement. I think 2x a week is plenty. At 3x a week I never did much at home because I needed to recover the day after. Even at 2x I sometimes feel like I get behind the therapy progression and need to catch up - ie the exercise difficulty is progressing faster than my recovery/strength building.

 

[cabland]

I hope you’re right about the improvement. I think 2x a week is plenty. At 3x a week I never did much at home because I needed to recover the day after. Even at 2x I sometimes feel like I get behind the therapy progression and need to catch up - ie the exercise difficulty is progressing faster than my recovery/strength building.

I found myself at the same spot with 3X a week. I hadn't really recovered from the last before I was at it again...and it is cumulative (IMO) so once I get behind, I only got moreso - the weekends were the only longer break. I am also spacing these apart (after the first week) with Monday/Thursday sessions. My last session was on Thursday and I can tell today (Saturday) is markedly better than yesterday (still very stiff). A lot of this, honestly, just seems (as @mendogal notes) to be that tincture of time.

 

[cabland]

Update - I'm 12 weeks out from my surgery today (11/13) - not quite 3 months. I am happy to say I am actually seeing some improvement in my knee pain and walking. It is still worse than before the surgery, BUT instead of the status quo of the last two months it is definitely getting better. I would often read here on BS about folks doing all kinds of stuff at 6 weeks out, etc...while I was doing nothing :( - YESTERDAY, however, I got tired of staring at the dirty "windows" in our kitchen, dining room and kitchen eating area/keeping room (7 French door panels and one small window) - 2 1/2 hours later I had completed cleaning the windows and screens (all exterior). My knee was "done" by the end, but 4 weeks ago this would have been impossible. Admittedly, this was a lot of "standing" (on a 2 step ladder sometimes) vs. walking, etc. but I was able to tolerate it.
Still a long way to go, but I'm hoping I'm at some kind of turning point. We'll see...
I have also stopped tracking my medication usage. I am taking 1/2 an oxycodone (2.5 mg total) at night when I go to bed along with 1/2 a Benadryl. During the day, I am generally using acetaminophen and occasionally ibuprofen. Sleep is still not awesome and I get fatigued still during the day. It is improving, but very slowly. Knee stiffness is perpetual...although in some moments my "other" knee feels as stiff as it starts to rejoin the knee party (as expected with increased movement).
Still on the oral antibiotics...mostly well tolerated (just 5 more months to go on those). That's it for today!

 

[EalingGran]

YESTERDAY, however, I got tired of staring at the dirty "windows" in our kitchen, dining room and kitchen eating area/keeping room (7 French door panels and one small window) - 2 1/2 hours later I had completed cleaning the windows and screens (all exterior). My knee was "done" by the end, but 4 weeks ago this would have been impossible. Admittedly, this was a lot of "standing" (on a 2 step ladder sometimes) vs. walking, etc. but I was able to tolerate it.

Crumbs! That seems a lot to me for 12 weeks. Especially the number of windows and the step ladder. I have had a pretty good recovery but I definitely couldn't have done that at 12 weeks. Well done-but I think you might need to take it easier. You don't want to overdo things or risk a fall with the step ladder.

 

[MSuki]

I haven’t had any desire to clean windows but I did have a noticeable energy increase the last few days. I changed sheets, ran some small errands, sat in my home office and did some work, and felt like I had a much more productive day than usual.

 

[cabland]

YESTERDAY, however, I got tired of staring at the dirty "windows" in our kitchen, dining room and kitchen eating area/keeping room (7 French door panels and one small window) - 2 1/2 hours later I had completed cleaning the windows and screens (all exterior). My knee was "done" by the end, but 4 weeks ago this would have been impossible. Admittedly, this was a lot of "standing" (on a 2 step ladder sometimes) vs. walking, etc. but I was able to tolerate it.

Crumbs! That seems a lot to me for 12 weeks. Especially the number of windows and the step ladder. I have had a pretty good recovery but I definitely couldn't have done that at 12 weeks. Well done-but I think you might need to take it easier. You don't want to overdo things or risk a fall with the step ladder.

You may be right....swept up some leaves Monday and had PT, and then watched one of the grandbabies for a couple hours yesterday...knee appears to be crying "ENOUGH!" today - and I'm back to PT tomorrow!

 

[mendogal]

Please stop pushing your new knee so hard. You shouldn't have to take every two or three days "off" to compensate for aggravating it.
Maybe skip PT or ask them for massage and ice instead?

 

[Layla]

knee appears to be crying "ENOUGH!" today - and I'm back to PT tomorrow!

Wondering if you made it to PT today and if so, how you're feeling?

Keep in mind that - Pain Is Your Body Asking For Change. It's likely too soon for you to be as ambitious as you've been lately. Ramping up activity in addition to attending PT is likely too much if your leg is protesting as you mentioned. Healing must take place first. Healing takes time and cannot be rushed. I hope you will allow yourself the TLC you need and deserve. Have a nice weekend!

 

[cabland]

Hey @mendogal and @Layla - I did go to PT but had an easier round on Thursday. They did introduce one new exercise which definitely highlights my biggest issue - the catching of "tissue" on the lateral side of my knee as I bend through it and the resistance and pain that is associated with it. It was just some little 4-6" high "hurdles" I had to walk over. I had to really concentrate to ensure I was lifting my foot (i.e. bending my knee) enough to clear them (tipped the first one over!).

Yesterday, the only thing I did was walk around the house...I did try "high stepping" a bit to simulate the little hurdle steps I was doing...just TRYING desperately to get that scar tissue or whatever it is to break up...if that's even what I am experiencing. Very frustrated as sometimes I feel like that particular feeling in my lateral knee is no different than in was shortly after surgery...especially since the medial side of my knee feels practically fine with just some minor tightness at higher inflexion. In my research (reading NIH studies), PT is often the first treatment to break up any tissue, but "movement" through the area seems to be the very thing that aggravates it...sigh....sorry ladies, just having a bit of a pity party for myself!

On the upside, attended my grandson's 1 year old Birthday party today, but did little more than sit or stand a bit there. If you are good, I may even treat you to a pic. Will take it easy tomorrow with just a little walking around the house and, of course watching the Super Bowl.

Thanks for lending an ear!

 

[mendogal]

Well, this is a safe place for folks to have a little pity party because everyone here has been through it at one time or another or several times!!! I'm glad you made it to a happier party for a while today!

Have you asked your ortho team or PT if they think it might be a part of the knee (like a tendon?) that's catching versus scar tissue? I ask because an irritated joint part won't like being manipulated or massaged. Might be worth asking.

 

[cabland]

Well, this is a safe place for folks to have a little pity party because everyone here has been through it at one time or another or several times!!! I'm glad you made it to a happier party for a while today!

Have you asked your ortho team or PT if they think it might be a part of the knee (like a tendon?) that's catching versus scar tissue? I ask because an irritated joint part won't like being manipulated or massaged. Might be worth asking.

I did ask my surgeon that specifically the last time I was there and he indicated it was scar tissue, but I'm not 100% sure how he can really tell and "scar tissue" does seem to be a catch-all they fall back on. I see him again in about 4 weeks, so I'll have to gauge it again with him then.

 

[WFD]

You might ask your PT to examine your knee and see what they think. A good hands-on PT with a lot of experience can sometimes be quite perceptive.

 

[cabland]

You might ask your PT to examine your knee and see what they think. A good hands-on PT with a lot of experience can sometimes be quite perceptive.

As you and @mendogal suggested, I did ask my PT today and she said she was "75% confident" it was scar tissue and would improve. Of course, my PT will likely be "over" before she ever has to see that play out....hmmm. She did remind me that we had already seen improvement in my walking which is true. Tomorrow is 3 months form my surgery...will report back on another week or so.

 

[Layla]

Hello cabland
Happy Three Month Anniversary!
Thanks for the updates. I hope you have a good week!
@cabland

 

[cabland]

Update - I am 16 weeks out from my surgery (as of yesterday) - just 8 days shy of 4 months. A few items:

PT
I finished my PT on Feb 22nd. I asked my therapist if she felt more PT would do me any good. She indicated that IF what I was feeling on the lateral (outer) side of my knee was going to get better, it would likely be due to time vs. more PT. Unfortunately, she also indicated she was no longer sure what I was feeling was scar tissue...did not say what she felt it was. Regardless, I have not attended PT since.

Infection
Labs - My infectious disease doctor ordered labs a couple of weeks ago and those all came back in range. To be clear, they are looking predominantly at the CRP and ESR results as these are INFLAMMATION markers of a sort. Both were at the bottom range of normal.
CT Scan - I also met with my infectious disease doctor last week and when I indicated I was still having pain (with accompanying redness, heat, etc.) they ordered a CT Scan. I got the scan yesterday. The radiologist report was, um...disappointing. I swear it looked like it took 5 minutes to write and basically said "patient has had a TBR....no signs of loosening". Pathetic. See more on this in the next section.

Meeting with Surgeon
I met with my surgeon today and told him I was continuing to experience pain and tissue catching/crunching/etc. in the lateral (outer) part of my knee. I also indicated I was having pain weight-bearing at start-up (when I first stand) or going up stairs (note: I cannot even go down stairs in a normal fashion). Ultimately, I said I was worse than before the surgery and this was materially impacting my life...that seemed to get his attention a bit more,

With regard to the aforementioned CT Scan I actually spent quite a bit of time looking at it and in one of the axial views, it appeared there was some degree of internal (that's the direction) rotation of the implant. I doubt it had "moved", but may have been placed that way from the get-go. It was not apparent, however, it was causing any of my issues. My surgeon did look at it with me and indicated it was normal and aligned correctly. I still have some concerns, but will table it for now.

My surgeon feels it is crepitus in that part of the knee aggravated by inflammation, etc. He gave me a steroid shot with an anesthetic in that side of my knee. We then waited about 10 mins for the anesthetic to kick in to see if the pain reduced....it did. The anesthetic really just tells us if the pain is from that area (which, I suppose, was already obvious) - effectively a diagnostic tool. I even did some "step-ups" right there in his office to be sure. Regardless, that wears off and then we wait to see if the steroid will reduce the inflammation enough to get me past this. He asked that I rest the knee for at least the next week or so. I am pretty skeptical (given my experience so far) since the steroid itself won't break up any scar tissue, etc. It may just be treating a symptom. I will say that over the last couple of weeks I did seem to get stuck in a perpetual inflammation state that I could not get out of (even with constant icing, etc.) - hoping this will at least break that cycle. I forgot to mention, he also drew a blood sample to send to the lab to look for infection (fluid "looked" good to him so he doubted it was infected, but will know for sure in a few days).

Finally, I asked him "How long will this likely take to show improvement if the steroid/rest works AND if this doesn't work what about an arthroscopic cleanup or even revision?". He said he hoped it would be much improved over the next 6 weeks - perhaps not 100%, but much better. He indicated he had done a handful of arthroscopic cleanups after TKR, but very few given the thousands of TKRs he has performed (pretty sure he is at 8-10K TKRs), as very few were ever needed. He was 95% confident it would resolve inside of a year. I pointed out that the "one year recovery" that folks experience is often an "70% or so recovered by 3 months and the last 30% take the remaining 9 months" and I was nowhere near that (note: Bonesmarties might disagree with my percentages, but I've talked to a lot of folks with knee replacements over the last few months and the majority seem as I described with a small number of outliers that go really bad - infections with revisions, etc. - and the rest of us in-betweeners). My surgeon told me not to compare myself (I know, I know - but hard not to!). With regard to doing a revision - he said he would NOT do it since he sees absolutely nothing wrong with the implant. Keep in mind, he has done a bunch of revisions so he doesn't appear to be "afraid" of them per se - for whatever that is worth. I see him again in 6 weeks.

Anyway, I've already typed a novel so I'll wrap it up. If nothing improves over the next month or so, I'm sure I'll be looking for a second opinion...I hope I don't have to go there.

Thanks All!

 

[EalingGran]

So sorry you still have such pain. I hope things settle with the injection and the infection tests are negative.