Revision TKR Chocolate at midnight<

[Dabber]

@Celle
Yes please, I would be grateful if you could put up the mantras and reading list.
I have already crossed swords with a physiotherapist.


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[Celle]

Here you go!
First are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist (PT) - to do it to you. exercise only gently.
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lie down!

Next is a FAQ (Frequently Asked Questions) thread.

And here are some very crucial articles
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

Healing: how long does it take?
Chart representation of TKR recovery
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling

Home physio (PT) and activity progress: suggestions
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

And then some wise words from members who have shared their experiences ...
Where are you in recovery?? (TKR)
Five “P’s” of knee recovery
TKR: work “smarter” and not “harder”
Recovering a knee - from one who knows!
It's never too late to get more ROM!
It's worth the wait for ROM

When dealing with your PT, don't bother to argue or try to convince him/her. Just calmly say that you will not allow anything that causes pain or forces your knee, and you will not overwork your knee.
It's your knee and you have the final say. The PT works for you and has to please you, not the other way round.

Best wishes.

 

[Pumpkin]

I have already crossed swords with a physiotherapist.

Sorry you had to deal with an aggressive PT. With my primary TKR I had 120 degrees flexion, with my revision I have 135 degrees. Did nothing more than heel slides after my revision.

 

[Dabber]

@Celle Physio is an hour in a knee class in a gym. It was never going to work for me. I spent my entire school and college days trying to avoid the gym. Anyway, I was 3 weeks out of surgery. We tackled the 6 week window of opportunity issue, the fact my ROM was only 80+ degrees; one thing I have is good leg raises so she prepared to put a 2 lb weight on my ankle, I refused.
I've requested a transfer to my practice physio where it's a gentle 1 to 1 for 20 mins.
I won't be pushed especially when my consultant has given me instructions to go very slowly and gently and aim for 90 degrees at 6 weeks.
@Pumpkln That's marvellous. I have a constrained revision joint, a Depuy TC3.
I'm reassessing my pain meds at the moment. I can manage around the house with one or no crutches although I'm doing very little at all, an occasional wander downstairs and bathroom breaks but pain has increased. I'm taking Tramadol and paracetamol, I've been looking at Josephine's regimes. I'm hoping to start taking small walks outside over the weekend, just in the garden if the sun is out. I'm mindful of only just having finished my long cancer treatment too.


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[Celle]

Hi Sue,
80+ degrees at about 4 weeks sounds pretty good to me! Like yours, my surgeon doesn't expect 90 degrees until 6 weeks.
Well done for refusing to be pushed too fast, or to use weights. I think weights are seldom needed and shouldn't be used until at least 3 months.

 

[Nana moon 27]

Hi Sue

I'm glad things are going okay. I was so pleased to hear you deal with a bullying physio well done you!
Hope you managed a little walk

Love Ann xxx

 

[Dabber]

I'm 2 months out now, so a little update.
I was advised to go down to one crutch or none indoors at 3 weeks but use 2 outside; that worked very well and I stopped using crutches outside at 6 weeks. I'm not walking far though, an occassional trip to the doctors or hospital that involves walking car to department and one or two very short food shopping top-up trips. I've had cardio (pacemaker) checks and my first post cancer treatment check-up in addition to my appointment with the osteo consultant at 3 weeks and GP appointments for pain control. I take a little walk out from time to time and we have a large garden I walk in.
I slept on my side, well tried at 6 weeks, pillow between the legs. Oddly I slept better immediately post op than now when although tired often don't sleep until 3.30am.
I had just 3 physio sessions, 2 group ones and one individual and was signed off on 4th April with a ROM of 0 extension and 108/116 depending on how it was measured (lying down or sitting).
I'm still having quite a lot of pain and take extended release Tramadol with Paracetamol and a top up of 50mg Tramadol if required and a 3 fold increase in Lyrica.
My left knee that was always the worst knee has swollen and is very painful too.
My operated knee gets quite warm, I ice and elevate as and when. It feels much more stable than my primary and I can manage stairs both up and down alternating feet, although going up is difficult.
I'm getting some whole leg/foot swelling if I'm on my feet much which I try not to be although I suspect it might be something to do with rather poor drainage from the lymph node that was biopsied in my groin.

My one problem is crepitus, it becomes painful by the end of the day. I see my consultant in early May so will take advice but any suggestions would be welcome, the crunching is audible and palpable over the patella.

 

[Celle]

Crepitus would be unusual after a TKR. Maybe it's this?
Clicking/clunking knee joint after surgery

Yes, do ask your surgeon about it.

 

[Dabber]

@Celle would it? I had awful clunking the first time around from the unstable joint and the spacer was worn in a very unusual way. I have a little clunking in the same place deep inside with this joint just when lying on my side and moving the leg but this is standing from sitting like velcro tearing apart, a creaky ripping sound on top of the kneecap, my husband can hear it and I can feel it with my hand. It's most odd.

 

[Pumpkin]

Dabber,
Sorry to hear you are having challenges with your revision, I am going to tag @Josephine to address your concerns.
I had a velcro ripping sound in my revision knee for quite awhile, as the scar tissue remodeled it is significantly less.

 

[Josephine]

Hi Dabber - here I am with my questions!

I'd like to ask you some questions if you don't mind, and it would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't compare this with the bone-on-bone pain you had before surgery! )

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how often are you icing your knee and for how long?

4. are you elevating your leg, how often and for how long?

5. What is your ROM - that's flexion (bend) and extension (straightness)

6. how swollen is your leg?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. what kind of PT exercises and exercises at home are you doing? How much and how often?
This is the most crucial question so please help me by using the format I have left as an example

At home:
say number of sessions each day
say exercise - enter number of reps and sets
say exercise - enter number of reps and sets

At PT:
say number of times you attend
say exercise - enter number of reps and sets
say exercise - enter number of reps and sets
say exercise - enter number of reps and sets


Can you tell me the exact site of your pain using this chart?
Please note the instructions in the smaller image

 

[Dabber]

@Josephine hello again. Hoping you are well.

Here we go:
1. Pain 0-2 resting rising to 5-6 after prolonged activity such as a hospital appointment.
2. I'm now taking 100mg Prolonged release Tramadol morning and evening with 1000mg paracetamol each time, more paracetamol if needed and 50mg Tramadol if needed. Pregabalin 2, 25mg morning and 3, 25mg evening.
3/4. As needed about twice/thrice a day for as long as the icepack is cold and usually at bedtime on 3 pillows until I wake up and take it off. All icing and elevating at the same time.
5. Extension 0 Flexion about 116.
6. Moderately swollen, whole leg including foot can swell sometimes with fluid.
7. I'm doing no housework except a bit of tidying up, a little cooking, load dishwasher and washer and hang out laundry, quite a lot of computing and studying, some planting seeds in trays indoors.
8. Heel slides 3-5 when I remember, maybe three times a day, straighten leg for extension, once or twice, perhaps twice or thrice a day. Standing bend leg up backwards from knee, stand on toes, bend leg when sitting back under the chair. Walk up and downstairs normally a few times a day, other times one step at a time. Walking outside and inside unaided, but not going out much, virtually no shopping, walking in garden to greenhouses etc.
No physio, I had 2 group gym knee classes and 1, 1 to 1 on 4th April and was signed off.
DRF2 is where I get the ripping sensation/sound that I can feel and hear when I stand from a chair. I often have whole leg ache and sometimes pain in ERF2. A bit of clunking going on deep inside.

I guess everything is good, it was just the near the surface ripping sound that concerned me.

Thank you.

 

[Josephine]

DRF2 is where I get the ripping sensation/sound that I can feel and hear when I stand from a chair. I often have whole leg ache and sometimes pain in ERF2. A bit of clunking going on deep inside.

So about here then?

1. Pain 0-2 resting rising to 5-6 after prolonged activity such as a hospital appointment.

okay

2. I'm now taking 100mg Prolonged release Tramadol morning and evening with 1000mg paracetamol each time, more paracetamol if needed and 50mg Tramadol if needed. Pregabalin 2, 25mg morning and 3 x25mg evening.

okay

3/4. As needed about twice/thrice a day for as long as the icepack is cold and usually at bedtime on 3 pillows until I wake up and take it off. All icing and elevating at the same time.

You never told me how long for which is the crucial bit. If you're doing it for only 2mins a time, you accomplish little or nothing. Ice for at least 40-60mins and more than 4 times a day.

5. Extension 0 Flexion about 116.

That's very good.

6. Moderately swollen, whole leg including foot can swell sometimes with fluid.

Really?

7. I'm doing no housework except a bit of tidying up, a little cooking, load dishwasher and washer and hang out laundry, quite a lot of computing and studying, some planting seeds in trays indoors. Virtually no shopping, walking in garden to greenhouses etc.

Okay good.

My comments in bold
your ROM is good - you don't need to do what I've crossed out
Heel slides 3-5 maybe three times a day
straighten leg for extension 1-2 times, perhaps twice or thrice a day
standing bend leg up backwards from knee
stand on toes
bend leg when sitting back under the chair
walk up and downstairs normally a few times a day, other times one step at a time -if it's purely for exercise then stop it. Only do what's necessary for every day things
walking outside and inside unaided but not going out much - okay

No physio, I had 2 group gym knee classes and one 1-1 on 4th April and was signed off - good

At 9 weeks out and with a very good ROM,you really don't need to do any exercises any more. Your walking and stairs on an as-needed basis will be quite sufficient. Besides which, things like sequential stairs, if it's a struggle to do, and standing on toes are what is causing your leg aches and other issues.

 

[Dabber]

Thank you Josephine.
Yes, the ripping sound is right over the patella and pain just below it. That's good about just carrying on with daily activities as exercise, I'm usually an active person who has a lifetime of gym avoidance but I haven't been very active over the last 3 years during treatment.
I generally ice for between 1/2 hr and an hour. I watch a whole recorded TV programme, with difficulty, lying down whilst I ice and elevate.
I think the swelling is to do with lymph not draining properly. I had a biopsy on the node in my groin but before that the TKR leg swelled because of lymphoma in that node. I mentioned it at my lymphoma consultation last week but it wasn't really picked up on, I'll talk about it at my next knee consultation. I have a lymphoedema nurse but by the time I saw her during treatment the problem had settled.
I'll be absent now for a few days, taking a restful break in Wales.

 

[Pumpkin]

Dabber,
Enjoy your time in Wales.

 

[Josephine]

I think the swelling is to do with lymph not draining properly.

It nearly always is, darling! And quite normal.

 

[Dabber]

I'm still struggling with my revision knee and am going to see my consultant tomorrow, I'll update then.

 

[newlybionic]

I'm sorry to hear that you are still having problems with your knee. Hopefully your OS can come up with an East fix.

 

[Pumpkin]

Sorry to hear you are still struggling, I will look for your update after your OS visit.

 

[Dabber]

I have scar tissue causing a lot of noise. It could be left, it isn't interfering with my ROM, removed during arthroscopy or by opening up the knee if the scar tissue is under the patella; both could mean it returns. Having a think about this one.
Any suggestions about arthroscopic scar tissue removal, please?
Also having investigations for nerve problems and hip bursitis.