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PKR Citylady52 Recovery thread Left medial PKR 12/22/20

Citylady52

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On Dec 22 had partial knee replacement (medial - inner) compartment of my left knee. As soon as I awoke from surgery, I felt pain along the lower third of my fibula area. I also had ankle pain when took my first steps. Ankle pain tends to "move around" (there was a lot of swelling and bruising but that has gone away). Made it hard to put weight on my foot. It was very uncomfortable to rest my leg out on the heel area.

I found out from the PA that the foot is put into a sort of "boot" during surgery and that could have injured my ankle and lower leg. Anyway, I was hoping it would heal up. It did start to get a little better but yesterday during PT in my home, the therapist had me put all my weight on that foot and try to climb a step. Ouch, excruciating pain. I had been making pretty good progress but now can barely walk with my cane. Took out the walker again (bear in mind I am about 2 and 1/2 weeks post-surgery).

It is Saturday and I am just going to rest hoping whatever it is heals up some over the weekend - will not do any of my exercises. I am SO UPSET. I have been complaining about this to the surgical team and really not getting a true diagnosis or any real help - not sure what is wrong.

There is a hard knot in the muscle along the outside lower calf. PT told me to apply heat to that area and massage with a ball every other day for 3 minutes. I have very skinny small ankles and have a history of metatarsal fractures...I also know that prior to the surgery my leg was slightly bowed out so I was walking leaning along the 5th metatarsal putting more pressure there.

I know the surgery must have realigned my bones and that could be part of it....but certainly not the whole thing as it hurt along my fibula immediately after surgery before I had even taken one step.
I had a 5th metatarsal stress fracture prior to the procedure and it had to be delayed in order for it to heal.

I know this is a lot of jumbled info. The pain in my leg and foot is almost worse than the knee at this point. I am ready to cry but trying to put on a brave face. I just feel helpless. I am not scheduled to see the surgeon until Feb19th when they will do xrays. Appreciate any help or feedback.
 

sistersinhim

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It did start to get a little better but yesterday during PT in my home, the therapist had me put all my weight on that foot and try to climb a step. Ouch, excruciating pain. I had been making pretty good progress but now can barely walk with my cane. Took out the walker again (bear in mind I am about 2 and 1/2 weeks post-surgery).
You should not do anything that hurts. Don't let your PT talk you into doing this again until you are more healed. I can't imagine a PT having you do this at only 2 weeks out. This is not a good thing to do this soon out, especially since you have a history with your ankle and foot. Did you tell your therapist this? If you did, I would refuse this therapist again. Tell them not to come back. You don't need them anyway. You can do anything you need to do by yourself with just normal daily activities to recovery successfully.
 

sistersinhim

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The following are our basic guidelines and should help get you started. As you read more on other members' recovery threads, you’ll get a better perspective of what to expect and what not to do, especially regarding PT.

Knee Recovery: The Guidelines

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now; they are almost certainly temporary
2. Control discomfort:
rest
ice
take your pain meds by prescription schedule (not when pain starts!)​
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.
4. PT or exercise can be useful BUT take note of these
5. Here is a week-by-week guide for Activity progression for TKRs


The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
 

Jockette

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I also had a partial, mine is a Patellofemoral. I had all kinds of pains here and there as this surgery does cause a lot of trauma, not just to the knee itself, but to the whole leg. Having issues with your foot just adds to all this surgical trauma.

I agree with sisitersinhim, try to avoid anything that hurts when you do it, or causes more pain and swelling in the 24 hours after doing it. In these early weeks all you need for your healing knee is gentle movements to give your knee mobility.
 
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Citylady52

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Hello everyone.

Yesterday was three weeks since surgery on my left knee - partial knee replacement of medial (inner compartment) which was outpatient due to Covid concerns.

A bit of background: I had been told years ago by orthopedic shoe store that I have an improper gait. My sneakers show wear at the front rather than the heel which is not normal. You are supposed to strike with your heel first. This probably contributed to osteo-arthritis of knee and also to my three metatarsal fractures and Morton’s neuroma. (Some on the right foot). All within the past 6 years.

On the affected left leg, X-rays showed that I was bone on bone and that the leg was slightly bowed out. I was bearing more weight on the outside of my foot. As a result, I sustained a 5th metatarsal stress fx prior to surgery and had to wear a boot and postpone my knee operation. I had always been slender to the point of marked underweight growing up but past couple of decades normal weight. Very long thin leg bones. I’m an ectomorph. I've also always had sort of wobbly ankles that are perhaps hyper flexible and had sustained sprains from walking on occasion. Never could learn to ice skate and pronate some.

In 2019 I started getting cortisone shots and they stopped working. This past summer, when i could no longer walk and do my typical 3-4 miles or even sleep without pain I decided I needed surgery. Over the course of about 18 months, I went to three “top” surgeons in Philly and only the one I used offered partial TKR. Supposed to be easier recovery. Dr. Neil Sheth at Pennsylvania Hospital (part of U Penn). He is younger than the other two, chief of ortho and has stellar academic credentials including multiple fellowships all over the world honing his craft, learning, teaching, donating time, doing 250 PKR's a year, doing robotic surgery, etc. and volunteering in poorer nations. He is also kind and warm. Has a great team and PA that is very responsive and helpful. Great Google reviews too from several ppl I know. The staff at the hospital gives rave reviews of him unsolicited. He does hips and knees. Sooooo, I’m hoping I too will eventually have a good outcome.

I’m a little sad and dejected right now. My friend of a friend had same surgeon for TKR about six months ago and claims she felt back to normal after four weeks! At about ten days out, I told her how i was doing. She made me feel badly saying I was doing worse with my partial than she did with her total. (Mind you, she has a PhD in Psychology, would think she’d be more supportive). When I told her that everyone recovers on their own trajectory, she said that she was just "more stubborn”. Anyway, I’ve written her off. Don’t need her “help”. ( Have you noticed that some weird ppl are attracted to the fields of psychology and psychiatry?! Lol).

As I said, yesterday is 3 weeks since surgery which was outpatient. Immediately upon awakening from the surgery I felt pain first in the lower left fibula area and Achilles. Was told foot gets put into a “boot “ during surgery that could have injured it some. I have a very good PT coming to the home and she guides me with the stretches etc.

However, she had me try a “step up” this past Friday. Was very painful and aggravated my foot. She said to stop. Like an idiot, I tried once more when she left. I’ve rested more since then. When I walk, try hard not to limp but every sixth or so step sharp pain in ankle or up leg and shin. This really was a setback as I had been doing better.

Up until then, I had been doing gentle stretches, heel slides, leg lifts etc. I’m sure you all know the drill. Went walking outside for a few blocks with cane first week. Hope I can again soon.

I went back to my gentle exercises yesterday. I’ve had good ROM from the beginning of over ninety degrees and extension as well. I did prehab prior to surgery. Hoping lower leg Achilles and ankle pain will subside soon. I’m also having a lot of trouble sleeping. I also learned from reading on this site, that because I was bowing out some and that my bones are re-aligned now, I am going to have some pain and issues from that. I also ordered two new pairs of sneakers to try online - cannot get to stores now obviously - one is a lighter weight NB and another is one from a company called orthofeet. I will let you know how they are when they arrive. My old NB sneakers are over six years old and heavy and clunky.

My knee looks good. After two weeks very little swelling and no bruising but sooooo stiff. If it wasn’t for foot and ankle issues and pain, I’d be doing ok. My ankle was literally purple a week after the surgery and heel very painful. I also liked that the surgeon used glue so I do not have a railroad track scar and the incision is maybe three inches long.

I do not have a Polar ice machine. My doctor does not like them due to ppl getting frostbite. I have multiple ice packs that I rotate from the freezer and do the icing and elevation as prescribed. I know some people sleep with them. As it is, I moved into the office on our first floor which has a comfortable sofa bed for the past few weeks but it is crowded. I did not want the hassle and mess of the polar ice machine.

I am having a lot of trouble sleeping which PA says is crucial to aid in healing. I was on Gabapentin Tylenol and Tramadol. I cannot take any Nsaids due to history of GI bleed. Also, get two baby aspirins daily to help prevent clots. Stopped taking Tramadol as was anxious to get off anything opioid like. This could have been a mistake - too soon.


Just got message from the PA. He thinks Tylenol is not enough if I am having so much pain cannot walk on it and am limping. . Wants me to go back on Gabapentin for nerve issue, and Tramadol to help with pain so that I can walk more comfortably and to add Melatonin before bedtime.

Still need a cane as walking not easy. Thanks for reading.
 

djklaugh

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@Citylady52 Welcome to BoneSmart :) It's sad that your alleged friend was so unsupportive and unhelpful to you! Sad to say that does happen but do not let yourself compare your experience to hers. From what you've written here it looks like you've had a long road up to having this surgery so you may expect your recovery to be different and perhaps long than another persons. You are only 3 weeks out from having major surgery! So take it easy, be kind to yourself, and know that we here at BoneSmart do support and encourage your journey. Some of our more knowledgeable knee folks will be along shortly to give you more information. Sorry I mostly know hips and shoulders.
 

Pumpkln

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@Citylady52
Welcome to BoneSmart, glad you joined us!
You are less than a month out from your TKR, pain can contribute the tightness you are experiencing. Your PA is correct in giving you stronger pain medications, reduced pain will help with swelling and the tightness you are feeling. Be sure you are taking the pain medications you have been prescribed on schedule, set an alarm for the middle of the night so you do not miss a dose.

The space in your knee joint is very small, it does not take much swelling to cause the tight band feeling you are having.

A lot of members rotate their ice packs, works just as well as one of the ice machines.

My guess is your friend has forgotten much of her recovery and is only recounting the more pleasant parts. You are right to ignore her.

Here is your copy of the Knee Recovery Guidelines, the articles are short and will not take long to read.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
ice
take your pain meds by prescription schedule (not when pain starts!)​

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

5. At week 4 and after you should follow this

6. Access these pages on the website


The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds


We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 

Pumpkln

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You'll notice that I have merged your two identical threads together. For several reasons, we prefer that you only have one recovery thread:
  • That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
  • If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
  • Having only one thread will act as a diary of your progress that you can look back on.
So please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we'll get it changed for you.
If you need an urgent response to a question, just tag a member of staff.

Many members bookmark their thread in their computer browser, so they can find it when they log on.
How can I find my threads and posts?
 
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Citylady52

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Thank you so much. Thanks for merging. I had an issue with the website. It looked as if my first posting was incomplete but it wasn’t. I tried to delete one but could not see how yo delete a post.
 
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Citylady52

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Update, You will notice above I have been having pain along lower fibula around back of ankle and even heel and arch since the surgery. I feel that possibly something was injured during the surgery. I decided to reach out to the foot and ankle surgeons that have treated me pteviously. They wrote back today that based on my descriprion and photo I sent, they think my peroneus longus tendon was injured. They want me resting it as much as possible, advised me to get an aircast, and limit knee exercises to just lying or seated ones. Anyone have any experience with this? Knee doing ok. Just after 3 wks ROM is 105 and extension at zero. prob cause I haven't been doing much pt! It is somewhat painful when I walk on foot at times. Are some exercises helpful to heal tendon or too soon? Will ask my PT at next visit.
 

sistersinhim

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My calf and foot hurt a lot after my replacement. I was told the OS would move my leg in all kinds of ways to check out the implant's movement. My feet even peeled after it. Different aches and pains cropping up on different areas of our bodies are normal.

I would do what your doctor says to do. You are injured and need to heal. Exercising will keep it inflamed. Your leg will let you know when you can increase your activities again. It's a trial and error thing.
 

Jaycey

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They want me resting it as much as possible, advised me to get an aircast, and limit knee exercises to just lying or seated ones.
If this is what your surgeon recommended then you should not be doing any exercises for that tendon injury.

Did they indicate how long this might take?
 
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Citylady52

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Thanks SO much for replies. Actually, the recommendation to rest it came from the foot and ankle surgeon doctors. Also suggested an AIRCAST with stirrup which arrives today. Disappointingly, as much as I like the surgical team, I’m sort of getting blowback from them in the sense that they don’t want to own the fact that manipulations done during surgery injured the peroneus longus. Their reluctance to address this issue and help me with it is what caused me to reach out to the foot and ankle surgeon. I have skinny weakish fragile ankles. Hindsight being 20:20, I wish I’d known more about how they do the surgery in advance and perhaps could’ve discussed this with the surgeon. Their solution was to prescribe more drugs for pain and nerve issues.
My PT came yesterday. She has a PhD and is very nice and bright. She called me after she spoke to the surgeon’s PA yesterday and reported that he tried to say that my pain was due to nerve and my back. She told me she pushed back on this. I have photo from shortly after surgery. The only place on my body that had dark purple bruising and swelling was around the rear and outside of my ankle. She told them it was a tendon issue agreeing with foot and ankle surgeon.
I don’t understand why they just don’t want to admit this. In any case,
It seems one really needs to be their own advocate. My job is to get myself better. I made this worse by attempting step ups last week. VERY STUPID. So now, I’m icing and elevating. Aircast coming today and some new NB sneakers giving me a lot of support and make my ankle feel better. I’ll do the foot slides and leg lifts that I can do sitting or lying down. As pain subsides, hopefully, I’ll resume doing calf stretches and toe rises. Also was told to roll my foot over a tennis ball. That feels pretty good. I’ll also ask my PT to help with this. Happy to have a good one who never pushes or gives guilt trips like I’ve been reading about on here.
Appreciate any more advice or comments. Hubby getting tired of being my nursemaid! Gotta get better. Lol.
 
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Citylady52

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They want me resting it as much as possible, advised me to get an aircast, and limit knee exercises to just lying or seated ones.
If this is what your surgeon recommended then you should not be doing any exercises for that tendon injury.

Did they indicate how long this might take?
Yes, they thought it might take a couple weeks and also said that as long as it is improving and not getting worse that that would be a good sign. I had this pain from immediately after surgery as I’ve written previously and complained about it to whomever would listen. It did start getting better until I did those step ups.
 

Jockette

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I’ll do the foot slides and leg lifts that I can do sitting or lying down.
Just do the foot slides very gently, to give your knee mobility, there is no need to see how far you can go.

There really isn’t any need to do leg lifts. I have low back issues and I found out with the first couple of leg lifts that they hurt my back. I stopped doing them. Several months later I tried one and my leg went all the way up, and I hadn‘t done any as an exercise.
 
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Citylady52

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“There really isn’t any need to do leg lifts. I have low back issues and I found out with the first couple of leg lifts that they hurt my back. I stopped doing them.”.

I think leg lifts are important for strengthening the quads which support the knee joint. To protect your back you need to contract your abdominal muscles and bend the other leg.
 

Celle

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I think leg lifts are important for strengthening the quads which support the knee joint.
Yes, they are important, but concentrating on doing them too early in recovery isn't helpful.
First, your knee needs to heal enough for you to be able to do leg lifts without causing pain and other problems. We recommend heal first and strengthen later.

During the early weeks of recovery you naturally regain some of your leg's strength, just through using it as you go about your normal activities of daily living.
Around 3 months post-op is about right for starting targetted strengthening exercises.
 
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Citylady52

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Thank you Celle. Understood. I actually did a lot of "pre hab" a couple of months before the surgery. I had very weak quads. So, I had been doing a lot of leg lifts. They do not bother me at all. I only do ten slowly. Those seated heel slides really hurt. I am looking gorward to being able to do stationary recumbent bike but PT said not allowed to for a while. Also, PT pointed out that a person with s partial as opposed to total knee has much more ROM etc just by virtue of what was done to the knee. Therefore, they are sometimes able to do some exercises sooner. I was ftightened because I could not even lift my leg at all after my procedure for about a week. And my PT explained that there's no way I was going to lift it because the muscle fibers are traumatized and they will not fire for a while until they recover enough. She said to just be patient and wait till it comes back and that's what I did. that's when I was able to do the leg lifts.
 
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Citylady52

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Today pain increased in my Achilles and ankle with some steps and it started swelling up again. I had to be on it for a shower. went outside for a one-block walk. had to do some things. kind of impossible to just stay off it. I'm very upset. it's not about the knee I don't think. I really do not know what to do. it hasn't been examined and I don't really even know for certain what is wrong. Foot and ankle PA basically came up with a diagnosis from my written description. I'm thinking I may need appt which is a super hassle now during covid and hard to get one. might try virtually. Bummed out. Sad. :(
 

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