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TKR Clunking with extension<

Baxty

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Thank you for this site. I continue to clunk whenever I extend my leg when I walk. My knee still swells. Does anyone have this at two years out? The giving away is getting better.
 

Celle

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Hello @Baxty - and :welome:

Please will you tell us the full date of your knee replacement and which knee it is, so we can make a signature for you? Thank you.:flwrysmile:

In some circumstances, it can be normal for your knee to make clunking or clicking noises. It's nothing to worry about, as long as it doesn't hurt.
Clicking/clunking knee joint after surgery

There's not a lot of logic to it. My right knee made noises for 4 years, but my left knee has always been silent.

Have you noticed that your knee swells when you've been more active than usual, or does it happen all the time?
Have you tried icing and elevating your leg, to reduce that swelling?
Ice to control pain and swelling
Elevation: the do's and dont's
 
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Baxty

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Hi. My right tkr was March 2016. The loud clunk affects my gait. It is always swollen and will swell randomly. Increased activity will also cause it to swell. I still will elevate it but do not bother with icing this far out. It still feels warmer than my left knee.
 

Celle

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If your knee is still warmer than your other knee, it is still possibly doing some healing beneath the surface That's a long time for it to happen.
Does it hurt at all when it's swollen?

I'm a bit out of my depth here, so I'm going to ask @Josephine , our Nurse Director, to advise you. She has many years of experience in orthopaedics.
She'll probably ask you a lot of questions. Do try to answer them as fully as possible, so she has all the information she needs, to advise you appropriately.
 

sistersinhim

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I continue to clunk whenever I extend my leg when I walk
Mine still clunks with every step. I can even make it clunk sitting down when I lift my leg up. It doesn't hurt, though. I have a lot more pain in the back of my knee, not the front.
 

Josephine

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I think you're actually 8 months out but I still wonder if perhaps you are doing too much.

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
 
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Baxty

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Yes, ask away I will be three years in March. I am just doing normal household stuff and sometimes riding an exercise bike at the lowest setting for 20 minutes.

Swelling can run between moderate and large. The clunking is louder. I am unsure of the flexion but I once reached 120 with home PT. I hope to see my old PT about the limping and the gait next week so I can get a measurement then. Extension is close to O.

A few weeks ago I had some constant medial pain that has cleared and a week at Christmas last year where I could not weight bear on it which was terrifying.

I was hopeful about it but am now feeling some concern. I am not back to what I was before surgery. It has randomly buckled a lot on me from the first time I walked on it. It has not buckled in a little while which is good. It has happened just cooking dinner.

When I last saw my surgeon he did not watch me walk. He came in the room and said I had a damaged knee and dashed out. The radiology tech noticed the difference in the swelling and commented that it looked uncomfortable.

Thank you for all you do.
 
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Josephine

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Here y'go then!

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 forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

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

3. how swollen is your leg compared to these?
ai63.tinypic.com_eta39s.jpg


4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

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

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.
 
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Baxty

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I believe you sent me the thr questions.

1. Biomet Vanguard cruciate- retaining replacement. ( I lost my ACL and still have the staples in the medical tibial metaphysis)

2. 2 but last night it woke me up, pain can be on the medial side where the tkr work was done.

3. No pain meds. 1 Aleve day when I can not function

4.No ice this far out. PT used to say ice stiffens things up. Swelling is an issue. Loud clunk with extension. Knee buckling is improved. Knee gets warm. Surgeon's nurse said it was increased blood flow.

5.elevating at least x 1 x 45 mins

6.doing all the household stuff but often ordering online instead of limping through a store

Exercise bike 20 minutes low setting few times a week
Swim in lake in summer
Walking the dog but I had to curtail with all the limping
Once a week: rowing machine 10 minutes and
elliptical - I have a hard time with this
bridges and clamshells 2 sets of 10

PT stopped long ago. I plan to see a former one soon for help with the gait.

Is the clunk TKR components or something else such as scar tissue? What else do you do for swelling? Thank you!
 

Josephine

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I believe you sent me the thr questions.
So I did! Must have clicked on the wrong line!
I've changed them now and they are quite different to the knee set so please check you've answered them correctly
 
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Baxty

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Flexion is 115, extension is good. I referred myself to my PT from two years ago who picked up on the walking trouble right away.
I do not have a sheet but I think it was three sets of 20 for all of these: bridges with a theraband,
leg in the theraband which is looped around something bend and not snap it back, and clam shells

Walking short steps heel toe
Biking on my bike at home as much as possible

I hope it helps! At least I have my PT.

Right tkr 2016
Right AcL reconstruction
Right meniscus
Right AcL, MCL
 

Celle

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bridges with a theraband,
leg in the theraband which is looped around something bend and not snap it back, and clam shells
Bridges and clamshells are not necessary for someone who's had a knee replacement, and we advise never using band to pull on your leg.
 
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Baxty

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He is trying to strengthen specific muscles so I can walk! How do you tell if an implant is loose? X-ray was fine.The band is around a looped object which I put my foot in and slightly bend and try not to snap it back. I keep snapping/ clunking my leg.
 

Josephine

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2. 2 but last night it woke me up, pain can be on the medial side.
Only two? Did you include all the other things I listed? Like soreness, burning, stabbing, throbbing, aching, swelling and stiffness?
3. No pain meds. 1 Aleve a day when I can not function
Ibuprofen is actually a pretty poor pain med and has other unpleasant side effects as well
Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers
NSAIDs Diclofenac. ibuprofen increase risk of heart problems: new study

So I suggest you try taking 1,000mg Tylenol instead, 3 to 4 times a day.
Flexion is 115, extension is good.
Hm well, that's pretty okay
4. No ice this far out. PT used to say ice stiffens things up.
Can do but it depends upon what your experience is.
Swelling is an issue. Loud clunk with extension. Knee buckling is improved. Knee gets warm. Surgeon's nurse said it was increased blood flow.
"increased blood flow"? I don't think so!
So if swelling is an issue why aren't you icing?
5.elevating at least x 1 x 45 mins
You need to elevate more than once a day. What's the good of that? You to elevate for at least 40-60mins and more than 4 times a day.
6.doing all the household stuff but often ordering online instead of limping through a store. Walking the dog but I had to curtail with all the limping.
Okay


Exercise bike 20 minutes low setting s much as possible - well the low setting is okay but 'as much as possible' is not. Restrict yourself to 10-15 mins max per day
rowing machine or elliptical 10 minutes - either or not both

three sets of 20 for all of these:
bridges with a theraband, clam shells - neither of these are good for you, neither are necessary for a TKR. And you should never use bands, weights or anything similar.
Walking short steps heel toe - don't be too rigorous with these. Normal walking is more than adequte

Is the clunk TKR components or something else such as scar tissue? What else do you do for swelling?
It'll be the components. Your nice soft cartilage has been replaced with metal and plastic so it's bound to make a noise now and again. Think of hitting a plastic spoon on a table top. I can still get a clunk on my right knee on demand!
 
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Baxty

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Hi,

Aleve is naproxyn not ibuprofen. I try not to take it. I am almost three years out: I do not want to elevate all day long. This tkr is getting worse. I could not really walk last night.
I snap the leg when I walk. Trying to help the vmo muscle for more control. I can not walk right.

I plan to start the exercises today. I have no choice. Knee is getting worse. Warm, effused, loud noisy hard to walk the knee. Ugh.
 

SusieShoes

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You're getting good advice on ways to reduce your swelling and pain. I wonder... have you seen another surgeon or sought a second opinion? At three years post-op, your knee should not be getting worse "just because." If you did something, like over-exercise or fall, that's one thing, but you haven't mentioned anything that would bring on your pain and swelling.

Give your knee a good rest, a few weeks, with lots of icing. See if things get better. If they don't, and your surgeon doesn't want to look into what's going on, see another surgeon who will look at your knee with unbiased eyes.
 
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Baxty

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Has anyone experienced pain driving?
 

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