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

[cabland]

I have had both an open lysis of adhesions and an arthroscopic lysis of adhesions.

The open LOA left me worse off. Experts in treating arthrofibrosis say that people prone to the condition are not suitable for open procedures such as these because the trauma simply generates more scar tissue.

The arthroscopic LOA was much more successful and gave me about 15° more RoM. Unfortunately I had an undiagnosed infection from a previous revision that destroyed the cement holding my tibial prosthetic in place, and it ultimately did a lot of damage to my tibia, necessitating another revision.

I'm glad you opted for the arthroscopic procedure. Recovery should be *much* easier than for the original TKR.

Thanks VERY much for this feedback and the details/history around your procedures (as rough as they were!). I am hopeful my infection is "gone" (still on oral antibiotics for another 2 months or so) and hasn't left any lasting issues...won't likely know until I stop the antibiotics unfortunately. Praying this arthroscopic procedure works out. I've had two arthroscopies on my other knee. Recovery for the first one wasn't nearly as easy as the second one. I suspect this arthroscopy will be a little rougher than the other two, but won't come close to TKR recovery!

 

[Caspa]

I would ask them to culture the tissue after clean up just to be sure the infection is gone. I really hope this next procedure works for you!!!

 

[cabland]

I have had both an open lysis of adhesions and an arthroscopic lysis of adhesions.

The open LOA left me worse off. Experts in treating arthrofibrosis say that people prone to the condition are not suitable for open procedures such as these because the trauma simply generates more scar tissue.

The arthroscopic LOA was much more successful and gave me about 15° more RoM. Unfortunately I had an undiagnosed infection from a previous revision that destroyed the cement holding my tibial prosthetic in place, and it ultimately did a lot of damage to my tibia, necessitating another revision.

I'm glad you opted for the arthroscopic procedure. Recovery should be *much* easier than for the original TKR.

I forgot to ask @WFD , did you do PT after your arthroscopic LOA? I did it after my first "regular" arthroscopic meniscectomy on my other knee, but skipped it after my second (I had the drill down after the first one). If so, did you take it easier, etc.

 

[WFD]

I forgot to ask @WFD , did you do PT after your arthroscopic LOA?

I did. After a TKR, Open LOA, Revision, and then Arthroscopic LOA, all in about a year and a half, I was a mess and needed the help. Some of it was counter-productive - the tibial prosthetic had broken loose and we didn't know it, so I was doing hip adduction and abduction for example with the cable machine, which was making things worse.

If you are in reasonably good shape after your TKR (except for RoM of course) then you can probably skip it, since as you say, you know the drill. Do everything you can to tamp down the inflammation, as for those of us prone to arthrofibrosis, that is the key.

 

[cabland]

Well, had the arthroscopic scar tissue removal this afternoon (aka lysis of adhesions). Unfortunately, I only got to talk to him for about 60 seconds after the surgery (and I was a little out of it) - he was back-to-back on surgeries, so I didn't get a lot of details. We did go over everything before the surgery again though so I was able to give him a "refresher" on what we had discussed a couple of weeks ago.
He did indicate he was able to get the knee to 140 degrees flexion so that was a pleasant surprise. I doubt I'll hold that number, but happy to have it to start. I see him in 2 weeks.
Icing/elevating/medicating since I got home. I'm sure I'll have a sleepless night ahead of me, but it is what it is!
More to come!

 

[mendogal]

I hope ice and being home let you get some good rest.

 

[cabland]

Quick update...Night of surgery was OK. Had some pain and took a few Oxycodone that afternoon and evening, but decent enough. Yesterday actually went really well. I elevated and iced the entire day and pain was controlled with acetaminophen and ibuprofen. Unfortunately, last night my wife noticed the back of my bandage was bloody and we realized the bandage was getting soaked...ugh. I tried calling my surgeon's after hours line, but their system had an issue and I could not get through. My wife and I managed to change the bandage successfully - thankful we happened to have enough miscellaneous gauze, etc.. One of the three "ports" was bleeding. I wrapped it tight (which, admittedly caused some pain), and called my surgeon's office this morning. We had taken pics of the bandage/wound/etc. and they asked me to come in.

Ultimately, they re-did the bandage with a lot of pressure/pad place on the "bleeder". Basically, I am to check the bandage tomorrow and change as necessary. They also want to me to minimize movement (not what I had hoped, but it is what it is). If the bleeding continues through Monday, they want to see me back in the office. Knee pain has ramped back up. Not sure if this if the tight bandage is aggravating that or what. Of course, all of this is giving me flashbacks to my original knee replacement and infection week! Praying it all resolves normally!

 

[Layla]

Lifting one for you, cabland
Hopefully the bleeding stops and you have a peaceful weekend.
Stay in touch...we'll be here.
@cabland

 

[mendogal]

Oh no, that must have been incredibly distressing. Hopefully bleeding and pain will abate and you can get some good rest.

 

[cabland]

Quick update - bleeding seems to have stopped (hooray), with no obvious signs of infection (double-hooray), but did minimal knee movement over the weekend (not ideal) Will be trying to introduce some bending today.

Can already tell the IT band area is the biggest pain point with a mild bend - which makes sense given the scar tissue on that side of my knee. Will give another update as I am able to bend more. Thanks all for the prayers!

 

[Layla]

Good news...you're making progress!
I hope you have a good week, cabland. Thanks for the update.
@cabland

 

[cabland]

Update - I'm 2 1/2 weeks out from the arthroscopic surgery to clean-up the scar tissue. The bleeding did stop and I got my stitches "removed" this past Tuesday. I say "removed" because I'm not sure they were all actually removed or if the nurse just clipped them off level with the skin (normally I am paying attention and didn't). Heck, I KNOW they weren't all actually "removed" as, the next day I saw a little piece poking out and I grabbed it and pulled it out myself! I close-up pic at one of the other ports shows a very tiny bit of the loop visible. Maybe they are ultimately "dissolving"???
Beyond that, two items:

1. My inner (medial) port area below by knee cap pushes outward (looks like a tiny mountain) whenever I extend my knee and put weight on it. I THINK this has been reducing the last day or so...we'll see.

2. The lateral port area well ABOVE my knee cap (note: I had 3 ports) is swollen and hard (like a knot). I was able to massage it today and it softened up, but after a while it has started firming back up. I kind of ASSUME it is scar tissue + edema + well, I don't know. It is warm and sore, but not hot, red or acutely painful. This was where he presumably did a lot of work to get the tissue that was catching on that lateral side. I am, as an aside, still on oral antibiotics for another month (from my original knee replacement 6+ months ago).

Anyone have anything similar to above (especially item 2)?

Note: I do have one pretty annoying challenge....I am changing insurance plans in a week and my surgeon is NOT on my new plan (despite me picking a plan he was supposedly on per the websites) - ugh!

 

[cabland]

Update - So I'm 7 months out from my TKR and now 6 weeks out from my arthroscopic scar tissue cleanup. As feared, I am worse than before the arthroscopic cleanup OVERALL, BUT the cleanup on the lateral side does seem to have been effective (the crunching there is all but gone and the knee overall feels a little looser).

Unfortunately, my 95 year old dad went into the hospital 2 1/2 weeks ago and is now in a memory care unit on hospice...that has had me up on the knee a lot w/o windows for rest/icing/etc....as a result haven't really made any progress in that time (mostly just focusing on pain and swelling control with meds as best I can - not great).

As to the items I reported in my previous post, my medial port area is sensitive but no longer protrudes...and, ironically, I pulled the remnant of another stitch from there.
The lateral port above the knee area is still sore, but the knot area has gotten smaller (still there a bit, but likely on its way down). I do have more pain in the lateral surgery area than I would have anticipated at 6 weeks.

I am hopeful I can get some stretching in over the next few days to try to resume making progress, but my schedule is what it is so I just have to go with the flow and let the Lord handle it (probably a generally good plan for any circumstance!). Really looking forward to at least getting back to where I was before this latest surgery...will try to check back in another 2 or 3 weeks.

Prayers for dad are appreciated (and mom as she deals with all this).

 

[Jockette]

I do have more pain in the lateral surgery area than I would have anticipated at 6 weeks.

Surgeries can take a lot longer to heal than we realize, especially since you were generally “only” about halfway healed from the original TKR. I fell about a year and a half ago and landed on my PKR. No major harm, but lots of swelling, bruising and loss of ROM. My soft tissues threw a fit, and took 2 months to heal. And that was just a major bump for my leg, no invasive surgery. And, I was almost 6 years post op!

so I just have to go with the flow and let the Lord handle it (probably a generally good plan for any circumstance!).

I agree!

Prayers for dad are appreciated (and mom as she deals with all this).

Will do!

 

[mendogal]

Holding you and yours in my heart. What a difficult time.

 

[Layla]

Checking in two months to date since your procedure. Hope you’re doing okay.
Prayers for you all as you face new challenges. @cabland
Please stay in touch.

 

[cabland]

Update - so I am 8 MONTHS from my LTKR today and (as @Layla points out) 2 MONTHS from my arthroscopic clean-up. As noted in my last update, the "crunching" feeling on the lateral side of my knee does appear to have been largely addressed by my arthroscopy and the knee feels loser. However, it almost feels "too loose" at this point. Each step has a more pronounced clunk/pop and it appears to be materially less stable. I cannot walk downstairs normally (one foot on each stair) yet either - am surprised at two months post arthroscopy I'm not back to being able to do that.

I am also experiencing pain from the lateral rear corner area of my knee. The latter often happens when I am sitting and move my knee a bit or am in the car and try to reposition it....indeed, it is a little like the pain I experienced before my TKR and is one of the things that prompted me to move forward with it. Heck, it hurts right now (at rest) as I am typing this. Ugh.

On the upside, my overall daily step count has increased (averaging 5000-6000/day now as opposed to the 4000 I was getting before the arthroscopy. Still, I can't say it is an easy or pleasant 6000. I pushed out my last ortho visit (which will be patient pay) a few more weeks to see if I can get further along...maybe request a steroid shot (but I'm not exactly sure "where").

Finally, my Dad went to be with the Lord at the end of June. All things considered, my Mom and the rest of us are doing reasonably well. Your prayers were and are appreciated as always. God Bless You, Bonesmarties!

 

[Layla]

Aww, big hugs on the loss of your precious dad. I am so sorry, cabland.

I hope given more time some of the issues you’re struggling with resolve. Please let us know how your next visit with the OS goes. I wish you only the best!
@cabland

 

[sistersinhim]

I am so sorry to read about your dad's passing. At least you know he is with the Lord! That is comforting.

You are still in the healing stage and will see more improvement as time goes on. Your knee wasn't but 6 months old when you had more surgery on it. It has to heal from that new surgery in May, plus the original TKR surgery. Patience is needed.

 

[WFD]

@cabland, how are things going?